Outcomes of arterial switch operation in patients with intramural coronary arteries at National Children’s Hospital

2021 ◽  
Author(s):  
Truong Nguyen Ly Thinh
Keyword(s):  
Coronary Arteries ◽  
Arterial Switch Operation ◽  
Good Health ◽  
Arterial Switch ◽  
Children's Hospital ◽  
Switch Operation ◽  
Children’S Hospital ◽  
Long Term Follow Up ◽  
Hospital Deaths

Objectives: To evaluate the outcomes of arterial switch operation (ASO) in a subgroup of patients who had intramural coronary arteries at National Children’s Hospital. Methods: From 2010 to 2016, 304 patients underwent ASO at National Children’s Hospital. In which, eighteen (5.9%) had intramural coronary arteries. These medical records of these patients were collected and retrospectively reviewed. Results: There were 10 male and 8 female in this group of patients. Patients with intramural coronary arteries had transposition of the great arteries (83.3%, n = 15) or Taussig - Bing anomaly (16.7%, n = 3). At the time of surgery, mean age was 69.5 ± 81.5 [11 - 321] days and mean weight was 3.9 ± 1.1 [2.5 - 6.3] kg. Mean bypass time and mean aortic cross - clamped time were 235 ± 90 [168 - 564] minutes and 149 ± 29 [100 - 255] minutes respectively. There were 3 deaths (16.7%): two hospital deaths (at 6 days and 26 days after ASO), one death after discharge (2 months later). One patient lost follow - up. Other 14 patients are in a good health status after discharge and free of re - intervention or reoperation related to the total correction with the mean follow - up time of 68.0 ± 38.5 [2 - 113] months. Conclusions: Intramural coronary arteries remain a rare coronary anatomic variant following ASO. The outcomes of ASO in this subgroup of patients is quite favorable. Long - term follow - up is necessary.

scholarly journals Impact of pulmonary artery reduction during arterial switch operation: 14 years follow-up

2020 ◽  
Vol 30 (6) ◽  
pp. 917-924
Author(s):  
Fernanda Lübe Antunes Pereira ◽  
Cristiane Nunes Martins ◽  
Roberto Max Lopes ◽  
Matheus Ferber Drummond ◽  
Fernando Antonio Fantini ◽  
...  
Keyword(s):  
Arterial Switch Operation ◽  
Z Score ◽  
Valve Regurgitation ◽  
Arterial Switch ◽  
Switch Operation ◽  
Long Term Follow Up ◽  
Z Scores ◽  
The Mean

Abstract OBJECTIVES Pulmonary artery/aorta (PA/Ao) size discrepancy plays an important role in the development of neoaortic root growth and valve regurgitation. Since 2004, we started using PA reduction to manage severe great vessels root mismatch at the time of arterial switch operation. The purpose of this study is to evaluate the impact of this technique in the mid- and long-term follow-up. METHODS Patients considered to have severe PA/Ao mismatch (>2:1 ratio) underwent resection of a 3- to 4-mm flap of the posterior PA wall. Patients submitted to this technique were followed up with clinical and image examinations. Echocardiographic findings were reviewed, and Z-scores were recorded to evaluate the incidence and progression of neoaortic root dilatation and valve regurgitation. RESULTS The median (Q1–Q3) follow-up time was 8 years (3–11). Before arterial switch operation, the median (Q1–Q3) Z-score of the PA annulus was 2.90 (2.75–3.75). At the latest follow-up, the median Z-score of the neoaortic annulus was 1.34 (0.95–1.66). The mean difference between the Z-scores of PA annulus and neoaortic annulus was 1.56 (P < 0.0001). The mean value of the sinus of Valsalva was +0.29 ± 1, that of sinotubular junction was +0.71 ± 0.6 and that of ascending Ao was +1.09 ± 0.7. There was no severe dilatation of the neoaortic annulus, neoaortic root or ascending Ao during follow-up. Neoaortic valve regurgitation was none or mild in 93% of patients. CONCLUSIONS PA reduction proved to be a feasible and low-risk procedure to approach PA/Ao mismatch in arterial switch operation. Mid- and long-term follow-up showed a tendency towards stabilization of the neoaortic root dilatation and satisfactory valve performance after the procedure. Further investigation is required with a larger population and longer-term follow-up.

scholarly journals The Coronary Arteries in Adults after the Arterial Switch Operation: A Systematic Review

2021 ◽  
Vol 8 (9) ◽  
pp. 102
Author(s):  
Leo J. Engele ◽  
Barbara J. M. Mulder ◽  
Jan W. Schoones ◽  
Philippine Kiès ◽  
Anastasia D. Egorova ◽  
...  
Keyword(s):  
Systematic Review ◽  
Coronary Arteries ◽  
Arterial Switch Operation ◽  
Acute Angle ◽  
Arterial Switch ◽  
Coronary Death ◽  
Coronary Imaging ◽  
Switch Operation ◽  
European Society Of Cardiology

Coronary artery status in adults long after the arterial switch operation (ASO) is unclear. We conducted a systematic review to provide an overview of coronary complications during adulthood and to evaluate the value of routine coronary imaging in adults after ASO, in light of current guidelines. Articles were screened for the inclusion of adult ASO patients and data on coronary complications and findings of coronary imaging were collected. A total of 993 adults were followed with a median available follow-up of only 2.0 years after reaching adulthood. Myocardial ischemia was suspected in 17/192 patients (8.9%). The number of coronary interventions was four (0.4%), and coronary death was reported in four (0.4%) patients. A lack of ischemia-related symptoms cannot be excluded because innervation studies indicated deficient cardiac innervation after ASO, although data is limited. Anatomical high-risk features found by routine coronary computed tomography (cCT) included stenosis (4%), acute angle (40%), kinking (24%) and inter-arterial course (11%). No coronary complications were reported during pregnancy (n = 45), although, remarkably, four (9%) patients developed heart failure. The 2020 European Society of Cardiology (ESC) guidelines state that routine screening for coronary pathologies is questionable. Based on current findings and in line with the 2018 American ACC/AHA guidelines a baseline assessment of the coronary arteries in all ASO adults seems justifiable. Thereafter, an individualized coronary follow-up strategy is advisable at least until significant duration of follow-up is available.

Early and Midterm Results of the Arterial Switch Operation: A 9-Year, Single-Center Experience

2017 ◽  
Vol 20 (1) ◽  
pp. 015
Author(s):  
Atakan Atalay ◽  
Ugur Gocen
Keyword(s):  
Septal Defect ◽  
Arterial Switch Operation ◽  
Double Outlet Right Ventricle ◽  
Single Center ◽  
Arterial Switch ◽  
Single Center Experience ◽  
Midterm Outcome ◽  
Switch Operation ◽  
Hospital Deaths

Background: The arterial switch operation (ASO) has become the surgical approach of choice for transposition of the great arteries. The aim of this paper was to describe the outcomes in patients who underwent arterial switch operation and to analyze the predictors of in-hospital mortality and further need for reoperation at a single-center institution. We reviewed our 9-year experience with arterial switch operation (ASO) for transposition of the great arteries (TGA) or Taussig-Bing anomaly (TBA) to assess the early and midterm outcomes.Methods: Between January 2007 and May 2016, 34 consecutive patients who underwent ASO for TGA with IVS; and TGA with ventricular septal defect (VSD); and double outlet right ventricle (DORV) with subpulmonary VSD at our institution were included in this retrospective study. The same surgeons operated on all patients. Patients’ charts, surgical reports, and echocardiograms were retrospectively reviewed. Median follow-up time ranged from 1 to 9 years, 54.2 (0.4-108) months.Results: There were 2 (5%) in-hospital deaths. Late death occurred in 1 (2.9%) of 32 survivors. One patient (2.9%) required reintervention. The freedom from reintervention rate was 95.9 ± 1.8% at 9 years. Two patients (3.9%) developed moderate neoaortic regurgitation during the follow-up and one patient underwent reoperation mainly for neopulmonary artery stenosis. The analysis showed that weight, cross-clamp (CC) time, cardiopulmonary bypass (CPB) time, and age of operation are strong predictors for mortality.Conclusion: ASO remains the procedure of choice for the treatment of various forms of TGA with acceptable early and midterm outcome, and can also be performed with a low risk of early mortality and satisfactory midterm outcomes even in a small-volume center. Early and midterm survival is excellent after arterial switch operation.

scholarly journals Long-term follow-up of arterial switch operation with an emphasis on function and dimensions of left ventricle and aorta☆

2009 ◽  
Vol 35 (4) ◽  
pp. 582-588 ◽  
Author(s):  
Kristof D.H.M. Vandekerckhove ◽  
Nico A. Blom ◽  
Shirin Lalezari ◽  
Dave R. Koolbergen ◽  
Marry E.B. Rijlaarsdam ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Arterial Switch Operation ◽  
Arterial Switch ◽  
Switch Operation ◽  
Long Term Follow Up

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.

Sign in / Sign up

Export Citation Format

Share Document