TY - JOUR
T1 - Left-Sided Reoperations After Arterial Switch Operation
T2 - A European Multicenter Study
AU - and the
AU - European Congenital Heart Surgeons Association (ECHSA) Study Group
AU - Vida, Vladimiro L.
AU - Zanotto, Lorenza
AU - Zanotto, Lucia
AU - Stellin, Giovanni
AU - Padalino, Massimo
AU - Sarris, Georges
AU - Protopapas, Eleftherios
AU - Prospero, Carol
AU - Pizarro, Christian
AU - Woodford, Edward
AU - Tlaskal, Thomas
AU - Berggren, Hakan
AU - Kostolny, Martin
AU - Omeje, Ikenna
AU - Asfour, Boulos
AU - Kadner, Alexander
AU - Carrel, Thierry
AU - Schoof, Paul H.
AU - Nosal, Matej
AU - Fragata, Josè
AU - Kozłowski, Michał
AU - Maruszewski, Bohdan
AU - Vricella, Luca A.
AU - Cameron, Duke E.
AU - Sojak, Vladimir
AU - Hazekamp, Mark
AU - Salminen, Jukka
AU - Mattila, Ilkka P.
AU - Cleuziou, Julie
AU - Myers, Patrick O.
AU - Hraska, Viktor
N1 - Publisher Copyright:
© 2017 The Society of Thoracic Surgeons
PY - 2017/9
Y1 - 2017/9
N2 - 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.
AB - 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.
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U2 - 10.1016/j.athoracsur.2017.04.026
DO - 10.1016/j.athoracsur.2017.04.026
M3 - Article
C2 - 28709661
AN - SCOPUS:85023158223
SN - 0003-4975
VL - 104
SP - 899
EP - 906
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 3
ER -