Left-Sided Reoperations After Arterial Switch Operation: A European Multicenter Study.

Vida, Vladimiro L; Zanotto, Lorenza; Zanotto, Lucia; Stellin, Giovanni; European Congenital Heart Surgeons Association Study Group, ECHSA; Kadner, Alexander; Carrel, Thierry (2017). Left-Sided Reoperations After Arterial Switch Operation: A European Multicenter Study. The Annals of Thoracic Surgery, 104(3), pp. 899-906. Elsevier 10.1016/j.athoracsur.2017.04.026

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BACKGROUND We sought to report the frequency, types, and outcomes of left-sided reoperations (LSRs) after an arterial switch operation (ASO) for patients with D-transposition of the great arteries (D-TGA) and double-outlet 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 DORV- TGA 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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery

UniBE Contributor:

Kadner, Alexander and Carrel, Thierry

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1552-6259

Publisher:

Elsevier

Language:

English

Submitter:

Daniela Huber

Date Deposited:

29 Nov 2017 07:50

Last Modified:

29 Nov 2017 07:50

Publisher DOI:

10.1016/j.athoracsur.2017.04.026

PubMed ID:

28709661

BORIS DOI:

10.7892/boris.105420

URI:

https://boris.unibe.ch/id/eprint/105420

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