20 years of arterial switch operation for simple TGA

Area of Science:

• Pediatric Cardiac Surgery
• Congenital Heart Disease Management

Background:

• Arterial switch operation (ASO) is the standard treatment for simple transposition of the great arteries (sTGA).
• Long-term outcomes and the incidence of supravalvular pulmonary stenosis (SPS) after ASO require ongoing evaluation.
• Understanding the evolution of SPS and the impact of surgical technique is crucial for improving patient care.

Purpose of the Study:

• To assess the long-term outcomes of the arterial switch operation (ASO) in patients with simple transposition of the great arteries (sTGA).
• To evaluate the incidence and progression of supravalvular pulmonary stenosis (SPS) following ASO.
• To determine the effect of surgical technique modifications on the development of SPS and the need for re-intervention.

Main Methods:

• Retrospective analysis of 133 patients who underwent ASO for TGA between 1991 and 2009.
• Review of echocardiographic and electrocardiogram data from pediatric cardiology and cardiac surgery databases.
• Mean follow-up duration of 9.2 years, utilizing last report method for data collection.

Main Results:

• Overall actuarial freedom from reoperation was 88.1% at 1 year, 78.5% at 5 years, and 76.9% at 10 years.
• Supravalvular pulmonary stenosis (SPS) required treatment in 17 patients.
• Postoperative mortality was low (0.8%); moderate valve regurgitation was observed in a subset of patients.

Conclusions:

• ASO is the preferred procedure for sTGA, demonstrating excellent long-term results with low morbidity and mortality.
• Supravalvular pulmonary stenosis (SPS) is a significant determinant of re-intervention rates.
• Surgical modifications, including extensive pulmonary artery mobilization, appear to reduce SPS incidence, warranting further investigation with longer follow-up.