Risk Factors for Reoperation After Arterial Switch Operation

Area of Science:

• Pediatric Cardiology
• Congenital Heart Surgery
• Cardiovascular Surgery

Background:

• Arterial switch operation (ASO) is a primary surgical repair for d-transposition of the great arteries (dTGA).
• Long-term outcomes and reoperation rates following ASO require continued investigation.

Purpose of the Study:

• To elucidate the timing, nature, and risk factors for reoperation after ASO in patients with dTGA.

Main Methods:

• Retrospective review of 403 patients undergoing ASO between 1986 and 2017.
• Multivariable analysis to identify risk factors for reoperation.
• Standardized techniques included pantaloon patch pulmonary artery reconstruction and intermittent neo-aortic root distension for coronary reimplantation.

Main Results:

• Pulmonary arterioplasty was the most common reoperation (2.7%), occurring at a median of 3.3 years postoperatively.
• Other reoperations included subvalvar right ventricular outflow tract reconstruction (2.2%), aortic valve repair/replacement (1.7%), aortic root replacement (1.2%), and coronary artery bypass graft/patch arterioplasty (1.2%).
• Taussig-Bing anomaly was a risk factor for any reoperation (P = .034), ventricular septal defect for AVR/r (P = .038), Taussig-Bing anomaly for RVOTR (P = .004), and pulmonary artery banding for ARR (P = .028).

Conclusions:

• Pantaloon patch pulmonary artery reconstruction and specific coronary reimplantation techniques have reduced outflow tract reoperations.
• Certain anatomic subsets have distinct risks for late reoperation, with pulmonary artery/RVOT reinterventions typically occurring earlier than aortic reinterventions.
• Close monitoring of high-risk subpopulations is crucial for optimizing long-term outcomes after ASO.