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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
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Published on: December 11, 2017

Thirty-year experience with the arterial switch operation.

Shirin Lalezari1, Eline F Bruggemans, Nico A Blom

  • 1Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands. s.lalezari@olvg.nl

The Annals of Thoracic Surgery
|August 30, 2011
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Summary

Arterial switch operation (ASO) offers good long-term survival for transposition of the great arteries. Coronary transfer issues during ASO increase mortality and reoperation risks.

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Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • The arterial switch operation (ASO) is a primary surgical treatment for transposition of the great arteries (TGA).
  • Long-term outcomes and risk factors associated with ASO require ongoing evaluation.

Purpose of the Study:

  • To evaluate the long-term results of ASO performed over 30 years.
  • To identify independent risk factors for mortality and reoperation following ASO in TGA patients.

Main Methods:

  • Retrospective analysis of 332 consecutive TGA patients undergoing ASO.
  • Utilized surgical reports, medical charts, and echocardiography for data collection.
  • Statistical analysis included Kaplan-Meier, logistic regression, and Cox regression.

Main Results:

  • In-hospital mortality was 11.4%; 15-year survival was 85.2%.
  • Risk factors for in-hospital mortality included cross-clamp time and absence of Lecompte maneuver.
  • Coronary problems during surgery and pacemaker implantation were linked to late mortality; age, arch abnormalities, and ventilation duration to reoperation.

Conclusions:

  • Thirty years of ASO experience demonstrates favorable survival and event-free rates.
  • Coronary transfer complications during ASO significantly impact late mortality and reoperation rates.
  • Neoaortic regurgitation is not a major long-term issue; specific coronary anatomies were not risk factors.