The arterial switch operation into the third and fourth decades of life

There is a large and growing population of adult survivors after the arterial switch operation (ASO). We sought to determine late outcomes in adult patients after the ASO.

Patients who underwent an ASO at a single institution were identified from the hospital database and retrospectively reviewed using hospital records.

From 1983 to 2020, 1010 patients with a biventricular circulation underwent an ASO. There were 29 (2.9%, 29/1010) early deaths and 928 local patients with follow-up. There were 128 (14%, 128/928) patients with more than 30 years of follow-up and 47 (5.1%, 47/928) patients with more than 35 years of follow-up. Freedom from any reintervention was 80% (95% confidence interval [CI], 77%-83%), 75% (95% CI, 70%-79%), and 73% (95% CI, 67%-78%) at 20, 30, and 35 years after ASO, respectively. Freedom from reoperation on the neoaortic root or valve was 95% (95% CI, 92%-96%), 89% (95% CI, 85%-92%), and 87% (95% CI, 82%-91%) at 20, 30, and 35 years after ASO, respectively. Risk factors for reoperation on the neoaortic root or valve on multivariate analysis were Taussig-Bing anomaly (P = .009, hazard ratio [HR], 3.2; 95% CI, 1.3-7.7), bicuspid neoaortic valve (P < .001, HR, 6.6; 95% CI, 2.8-15.7), and cardiopulmonary bypass time (P = .001, HR, 1.0; 95% CI, 1.0-1.1). New York Heart Association class at last follow-up was I in 92% (118/128) patients with more than 30 years of follow-up.

One quarter of patients require reoperation at 30 years after the ASO. Neoaortic root or valve surgery, although generally uncommon, is greater in patients with Taussig-Bing anomaly and bicuspid neoaortic valve.