The arterial switch operation: 25-year experience with 258 patients

Area of Science:

• Pediatric Cardiac Surgery
• Congenital Heart Disease Repair
• Surgical Outcomes Research

Background:

• The arterial switch operation (ASO) for transposition of the great arteries (TGA) has evolved, with a shift from Gore-Tex patches to redundant pantaloon pericardial patch (RPPP) for pulmonary artery reconstruction.
• The (U-shaped) coronary artery button technique is utilized for coronary reimplantation during ASO.

Purpose of the Study:

• To investigate overall mortality following the arterial switch operation.
• To identify factors influencing surgical reintervention rates for the neopulmonary artery, neoaorta, and coronary arteries after ASO.

Main Methods:

• A retrospective chart review was conducted on 258 patients who underwent ASO between 1983 and 2007.
• Kaplan-Meier curves were used for time-to-event analysis, and Cox proportional hazard modeling identified predictors of reintervention.

Main Results:

• Overall mortality decreased across study eras (15% to 7%).
• The RPPP demonstrated a significantly lower neopulmonary artery reintervention rate (4%) compared to Gore-Tex patches (14%).
• Complex anatomy was associated with increased risk for neopulmonary artery (HR 3.3) and neoaortic (HR 3.5) reintervention. Complex coronary anatomy predicted coronary reintervention (HR 17.9).

Conclusions:

• Arterial switch operation outcomes have improved, with decreased mortality and neopulmonary artery reintervention after adopting RPPP.
• The (U-shaped) coronary artery button technique is linked to low coronary reintervention rates.
• Complex patient anatomy, prior pulmonary artery banding, and coronary artery anatomy are significant predictors for neoaortic reintervention.