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Successful late reintervention after the arterial switch procedure
Sanjiv K Gandhi1, Frank A Pigula, Ralph D Siewers
1Department of Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh, Pennsylvania 15213-2583, USA. gandhis@heart.chp.edu
Insights
Late reintervention after the arterial switch operation for transposition of the great arteries is occasionally needed, most commonly for neopulmonary stenosis. These interventions are generally well-tolerated in pediatric patients.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease Management
- Cardiovascular Interventions
Background:
- The arterial switch operation is the standard treatment for transposition of the great arteries.
- Long-term outcomes and potential complications require ongoing investigation.
Purpose of the Study:
- To evaluate the frequency and types of late invasive reinterventions after the arterial switch operation in children.
- To assess the safety and outcomes of these reinterventions.
Main Methods:
- Retrospective analysis of pediatric patients who underwent the arterial switch operation between 1985 and 2000.
- Detailed review of reintervention indications, procedures, and outcomes.
Main Results:
- Operative survival was 89% in 144 patients.
- 23% of survivors required late reintervention, with neopulmonary stenosis (16%) being the most frequent indication.
- Reinterventions, including reoperations and percutaneous procedures, showed no mortality or major morbidity.
Conclusions:
- Invasive reintervention is occasionally necessary after the arterial switch operation, primarily for neopulmonary stenosis.
- Reintervention is safe and well-tolerated in this pediatric population.
- Long-term surveillance for late complications is crucial for patients who have undergone the arterial switch operation.
Background:
The arterial switch operation is the therapy of choice for transposition of the great arteries.
Methods:
A retrospective analysis of all children undergoing the arterial switch operation between November 1985 and October 2000 was conducted, highlighting the frequency and nature of late invasive reintervention.
Results:
One hundred forty-four children were operated on. Operative survival was 89% (128 of 144). Late reintervention was required in 23% (29 of 128) of survivors. Neopulmonary stenosis (PS) was the most common complication requiring treatment, occurring in 16% (21 of 128) of patients. Eleven of 21 patients with PS required reoperation, whereas 10 were managed with percutaneous techniques. Other indications for reintervention included aortic arch obstruction (3 patients), ventricular septal defect (with PS in 2 patients), bronchial stenosis (2 patients), coronary stenosis (2 patients), aortic stenosis (with PS in 1 patient), and residual atrial septal defect (1 patient). There has been no mortality or major morbidity in those children who have undergone reintervention.
Conclusions:
Invasive reintervention after the arterial switch operation is occasionally required. The most common indication is PS. Reintervention is well tolerated by those children who require it. Continued follow-up for late complications is required in this patient population.