Background. We sought to report the frequency, types, and outcomes of left-sided reoperations (LSRs) after an arterial switch operation (ASO) for patients with Dtransposition of the great arteries (D-TGA) and doubleoutlet right ventricle (DORV) TGA-type. Methods. Seventeen centers belonging to the European Congenital Heart Surgeons Association (ECHSA) contributed to data collection. We included 111 patients who underwent LSRs after 7,951 ASOs (1.4%) between January 1975 and December 2010. Original diagnoses included D-TGA (n[99) and DORV TGA-type (n[12). Main indications for LSR were neoaortic valve insufficiency (n [ 52 [47%]) and coronary artery problems (CAPs) (n [ 21 [19%]). Results. Median age at reoperation was 8.2 years (interquartile range [IQR], 2.9–14 years). Seven patients died early after LSRs (6.3%); 4 patients with D-TGA (5.9%) and 3 patients with DORV TGA-type (25%) (p [ 0.02). Median age at last follow-up was 16.1 years (IQR, 9.9–21.8 years). Seventeen patients (16%) required another reoperation, which was more frequent in patients with DORVTGA type (4 of 9 [45%]) than in patients with D-TGA (13 of 95 [14%]). Late death occurred in 4 patients (4 of 104 [3.8%]). The majority of survivors were asymptomatic at last clinical examination (84 of 100 [84%]). Conclusions. Reoperations for residual LSRs are infrequent but may become necessary late after an ASO, predominantly for neoaortic valve insufficiency and CAPs. Risk at reoperation is not negligible, and DORV TGA-type anatomy, as well as procedures on the coronary arteries, were significantly associated with a higher morbidity and a lower overall survival. Recurrent reoperations after LSRs may be required.
Left-Sided Reoperations After Arterial Switch Operation: A European Multicenter Study
Padalino M;
2017-01-01
Abstract
Background. We sought to report the frequency, types, and outcomes of left-sided reoperations (LSRs) after an arterial switch operation (ASO) for patients with Dtransposition of the great arteries (D-TGA) and doubleoutlet right ventricle (DORV) TGA-type. Methods. Seventeen centers belonging to the European Congenital Heart Surgeons Association (ECHSA) contributed to data collection. We included 111 patients who underwent LSRs after 7,951 ASOs (1.4%) between January 1975 and December 2010. Original diagnoses included D-TGA (n[99) and DORV TGA-type (n[12). Main indications for LSR were neoaortic valve insufficiency (n [ 52 [47%]) and coronary artery problems (CAPs) (n [ 21 [19%]). Results. Median age at reoperation was 8.2 years (interquartile range [IQR], 2.9–14 years). Seven patients died early after LSRs (6.3%); 4 patients with D-TGA (5.9%) and 3 patients with DORV TGA-type (25%) (p [ 0.02). Median age at last follow-up was 16.1 years (IQR, 9.9–21.8 years). Seventeen patients (16%) required another reoperation, which was more frequent in patients with DORVTGA type (4 of 9 [45%]) than in patients with D-TGA (13 of 95 [14%]). Late death occurred in 4 patients (4 of 104 [3.8%]). The majority of survivors were asymptomatic at last clinical examination (84 of 100 [84%]). Conclusions. Reoperations for residual LSRs are infrequent but may become necessary late after an ASO, predominantly for neoaortic valve insufficiency and CAPs. Risk at reoperation is not negligible, and DORV TGA-type anatomy, as well as procedures on the coronary arteries, were significantly associated with a higher morbidity and a lower overall survival. Recurrent reoperations after LSRs may be required.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
