Left-Sided Reoperations After Arterial Switch Operation: A European Multicenter Study

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Arterial switch operation (ASO) is a primary surgical repair for D-transposition of the great arteries (D-TGA) and TGA-type double-outlet right ventricle (DORV).
• Left-sided reoperations (LSRs) may be necessary following ASO to address residual or progressive complications.

Purpose of the Study:

• To determine the frequency, indications, and outcomes of LSRs after ASO in patients with D-TGA and DORV TGA-type.
• To identify risk factors associated with morbidity and mortality in patients undergoing LSRs.

Main Methods:

• A multi-center retrospective study involving 17 European Congenital Heart Surgeons Association (ECHSA) centers.
• Data from 111 patients who underwent LSRs after 7,951 ASOs between 1975 and 2010 were analyzed.
• Indications for LSR included neoaortic valve insufficiency (47%) and coronary artery problems (19%).

Main Results:

• LSRs were performed in 1.4% of patients after ASO, with a median age of 8.2 years at reoperation.
• Early mortality was 6.3%, with significantly higher rates in DORV TGA-type patients (25%) compared to D-TGA (5.9%).
• 16% of patients required further reoperations, and 84% of survivors were asymptomatic at last follow-up.

Conclusions:

• LSRs are uncommon but essential for managing late complications after ASO, primarily neoaortic valve insufficiency and coronary artery issues.
• Reoperation carries significant risk, particularly for DORV TGA-type anatomy and coronary artery procedures, impacting morbidity and survival.
• Recurrent reoperations may be necessary, highlighting the long-term management challenges in these complex congenital heart defects.