scholarly journals Risk Factors for Reoperation After Arterial Switch Operation

2021 ◽  
Vol 12 (4) ◽  
pp. 463-470 ◽  
Author(s):  
Parth M. Patel ◽  
Jeremy L. Herrmann ◽  
Eric Bain ◽  
Joseph M. Ladowski ◽  
Cameron Colgate ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Pulmonary Artery ◽  
Aortic Root ◽  
Arterial Switch Operation ◽  
Outflow Tract ◽  
Arterial Switch ◽  
Switch Operation ◽  
Pulmonary Artery Reconstruction ◽  
Artery Reconstruction

Objective: The timing and nature of and risk factors for reoperation after the arterial switch operation in the setting of d-transposition of the great arteries requires further elucidation. Methods: A total of 403 patients who underwent arterial switch operation from 1986 to 2017 were reviewed. Institutional preference was for pulmonary artery reconstruction using a pantaloon patch of fresh autologous pericardium. The targets for coronary artery reimplantation were identified by intermittent root distension. Multivariable analysis was used to identify risk factors for reoperation. Results: Median follow-up was 8.6 years (interquartile range [IQR]: 2-16.9). Pulmonary arterioplasty was the most common reoperation (n = 11, 2.7%) at 3.3 years (IQR: 1.4-11.4) postoperatively. Subvalvar right ventricular outflow tract reconstruction (RVOTR) was required in nine (2.2%) patients at 2.5 years (IQR: 1.1-5.3) postoperatively. Aortic valve repair or replacement (AVR/r) was required in seven (1.7%) patients at 13.6 years (IQR: 10.0-15.8) postoperatively. Aortic root replacement (ARR) and Coronary Artery Bypass Graft/coronary patch arterioplasty were required in five (1.2%) patients each at 13.6 years (IQR: 11.0-15.3) and 11.3 years (IQR: 2.3-13.6) postoperatively, respectively. Taussig-Bing anomaly was a risk factor for any reoperation ( P = .034). Risk factors for specific reoperations included ventricular septal defect for AVR/r ( P = .038), Taussig-Bing anomaly for RVOTR ( P = .004), and pulmonary artery banding for ARR ( P = .028). Conclusions: Pantaloon patch pulmonary artery reconstruction and intermittent neo-aortic root distension during coronary reimplantation have minimized respective outflow tract reoperations. Certain anatomic subsets carry different risks for late reoperation, and pulmonary artery and/or RVOT reinterventions tend to occur sooner than aortic reinterventions. Special attention to these higher risk subpopulations will be critical to optimizing lifelong outcomes.

Late Results After Extended Pulmonary Artery Reconstruction in the Arterial Switch Operation

2006 ◽  
Vol 81 (6) ◽  
pp. 2259-2266 ◽  
Author(s):  
Michael V. Ullmann ◽  
Matthias Gorenflo ◽  
Christian Bolenz ◽  
Christian Sebening ◽  
Michael Goetze ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Arterial Switch Operation ◽  
Late Results ◽  
Arterial Switch ◽  
Switch Operation ◽  
Pulmonary Artery Reconstruction ◽  
Artery Reconstruction

Late complications and pathological findings of the arterial switch operation

2013 ◽  
Vol 24 (1) ◽  
pp. 167-169
Author(s):  
Yoshinori Enomoto ◽  
Kenji Mogi ◽  
Yoshiharu Takahara
Keyword(s):  
Pulmonary Artery ◽  
Aortic Root ◽  
Arterial Switch Operation ◽  
Late Complications ◽  
Pulmonary Artery Stenosis ◽  
Severe Aortic Regurgitation ◽  
Arterial Switch ◽  
Bentall Procedure ◽  
Switch Operation ◽  
Aortic Root Dilatation

AbstractWe describe aortic root dilatation, severe aortic regurgitation, and pulmonary artery stenosis that were accidentally diagnosed 23 years after the arterial switch operation for transposition of the great arteries in situs inversus. We successfully performed the modified Bentall procedure and pulmonary artery reconstruction. The pathology of the dilated aortic root revealed intimal atherosclerosis and linear necrosis of the tunica media, suggesting the vulnerability of the pulmonary artery to systemic pressure.

Incidence and Risk Factors for Right Ventricular Outflow Tract Obstruction after the Arterial Switch Operation

2018 ◽  
Vol 67 (01) ◽  
pp. 037-043
Author(s):  
Keti Vitanova ◽  
Jelena Pabst von Ohain ◽  
Masamichi Ono ◽  
Daniel Tanase ◽  
Melchior Burri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Right Ventricular ◽  
Aortic Arch ◽  
Arterial Switch Operation ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Outflow Tract ◽  
Aortic Arch Anomalies ◽  
Arterial Switch ◽  
Switch Operation

Background The aim of this study was to evaluate the incidence and risk factors for the development of right ventricular outflow tract obstruction (RVOTO) after the arterial switch operation (ASO). Methods Between 1983 and 2014, a total of 688 patients underwent ASO. RVOTO was defined as any obstruction of the right ventricular outflow tract (RVOT) requiring reintervention. Results RVOTO developed in 79 patients (11%) at a median time of 3.8 years (range, 1 day–23.6 years) after ASO. Freedom from RVOT reintervention was 96 ± 1, 89 ± 1, and 83 ± 2% at 1, 10, and 25 years, respectively. Independent risk factors for the development of RVOTO in a Cox's regression model were side-by-side great arteries (p < 0.001), aortic arch anomalies (p < 0.001), use of a pericardial patch for augmentation of the coronary buttons (p < 0.001), and a peak gradient more than 20 mm Hg over the RVOT at discharge (p < 0.001). Conclusion The incidence of RVOTO after ASO is not negligible. Complex morphology, such as side-by-side great arteries and aortic arch anomalies influences the development of RVOTO.

Risk Factors for Neo-Aortic Root Enlargement and Aortic Regurgitation Following Arterial Switch Operation

2004 ◽  
Vol 25 (4) ◽  
pp. 329-335 ◽  
Author(s):  
C. J. McMahon ◽  
W. J. Ravekes ◽  
E. O’Brian Smith ◽  
S. W. Denfield ◽  
R. H. Pignatelli ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Regurgitation ◽  
Aortic Root ◽  
Arterial Switch Operation ◽  
Arterial Switch ◽  
Switch Operation ◽  
Aortic Root Enlargement

Alternative pulmonary artery reconstruction technique in the arterial switch operation

2021 ◽  
Author(s):  
Hisayuki Hongu ◽  
Masaaki Yamagishi ◽  
Yoshinobu Maeda ◽  
Keiichi Itatani ◽  
Masatoshi Shimada ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Arterial Switch Operation ◽  
Late Complication ◽  
Late Complications ◽  
Reconstruction Technique ◽  
Reconstruction Method ◽  
Arterial Switch ◽  
Switch Operation ◽  
Longitudinal Extension

Abstract OBJECTIVES Late complications of arterial switch operations (ASO) for transposition of the great arteries, such as neo-pulmonary artery (PA) stenosis and/or neoaortic regurgitation, have been reported. We developed an alternative reconstruction method called the longitudinal extension (LE) method to prevent PA bifurcation stenosis (PABS). METHODS We identified 48 patients diagnosed with transposition of the great arteries and performed ASO using the Lecompte manoeuvre for neo-PA reconstruction. In 9 consecutive patients (from 2014), the LE method was performed (LE). Before 2014, conventional techniques were performed in 39 patients (C). The median body weight and age in the LE and C groups were 3.0 and 3.1 kg and 12 and 26 days, respectively. In the LE group, 1 patient underwent bilateral PA banding before ASO. In C, PA banding and arch repair were performed in 1 patient each. Patients who received concomitant procedures were included. RESULTS The median follow-up in LE and C groups was 1.9 and 10.1 years, respectively. Early mortality/late death was not found in group LE and in 1 patient in group C. Only 1 case required ascending aorta sliding plasty in LE, and 8 patients needed PA augmentation for PABS in C. The median velocity of right/left PA was measured as 1.6/1.9 m/s in LE and 2.1/2.3 m/s in C, so it showed a lower value in LE. CONCLUSIONS Excellent mid-term results were obtained with the LE method. It was considered a useful procedure in preventing PABS, which is a primary late complication of ASO. Further follow-up and investigations are needed.

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