Prevalence of Pulmonary Artery Interventions Following the Arterial Switch Operation

BackgroundPulmonary artery (PA) stenosis is a known complication of the arterial switch operation (ASO) for the repair of transposition of the great arteries. This has previously been described in small, single-center reports. This study aimed to examine the incidence of PA intervention and the impact of center volume in a large national sample.MethodsA multicenter, retrospective cohort study of infants undergoing neonatal ASO from January 2005 to December 2021 at hospitals in the Pediatric Health Information System database was performed. Primary outcomes were the overall prevalence of PA intervention and cumulative incidence rate by center volume tertile. A Cox proportional hazard model clustered by center and partitioned at 1.5 years, assessed the impact of volume on intervention rates.Results7411 infants underwent ASO; 1262 (17%) had a PA intervention. The median time to intervention was 0.8 years. Those who underwent intervention had longer initial hospital length of stay (22 vs 18 days, p < .01), lower birth weight (3000 gm vs 3150 g, p < .01), and were more likely to have a ventricular septal defect (59.3% vs 43.6%, p < .01). The incidence of PA intervention differed significantly by center volume over time with hazard ratios of 2.14 (95% CI, 1.71-2.69) and 1.32 (95% CI, 1.04-1.68) for the lowest and middle volume tertile compared with the highest volume tertile, respectively.ConclusionsPA intervention is common after ASO with the majority occurring in the first year. Larger volume centers had lower intervention rates. Studies are needed to identify modifiable factors to decrease PA intervention rates.