Related Experiment Video
Updated: Jan 12, 2026
Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Long-term Outcomes of Standardized Strategy in Arterial Switch Operation: An 18-Year Review in a Single Center
Jae Hong Lee1, Jae Gun Kwak2, Susan Taejung Kim3
1Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.
Background And Objectives:
Despite advances in the outcomes of arterial switch operation (ASO), long-term complications such as neo-aortic regurgitation (AR), neo-aortic root dilatation (ARD), neo-pulmonary stenosis (PS), and coronary artery-related events (CARE) pose challenges. We aimed to evaluate the long-term outcomes of ASO following a consistent surgical strategy adopted since 2003.
Methods:
We retrospectively analyzed 133 patients who underwent ASO between January 2003 and June 2021. Consistent surgical strategies included the trap-door method for coronary artery transfer, preservation of the neo-sinotubular junction, and extensive mobilization of pulmonary artery branches. Clinical outcomes and risk factors for adverse events were assessed.
Results:
Among the 133 patients, 64 had transposition of the great arteries (TGA) with intact ventricular septum (IVS), 52 had TGA with ventricular septal defect (VSD), and 17 had Taussig-Bing anomaly (TBA). Operative mortality was 5.2% (n=7), with no late mortality over a median follow-up of 7.1 years. Freedom from reoperation and the composite of reoperation and re-intervention rates at 15 years were 80.7% and 74.0%, respectively. Freedom from significant neo-AR (≥ mild-to-moderate), neo-ARD (z-score ≥3.0), neo-PS (peak velocity >3.0 m/s or requiring re-intervention), and CARE at 15 years was 91.7%, 37.1%, 77.7%, and 92.3%, respectively. Complex TGA morphological subtypes (TBA > TGA-VSD > TGA-IVS) had higher neo-ARD (log-rank p<0.001) and composite of reoperation and re-intervention rates (log-rank p=0.021).
Conclusions:
Our surgical outcomes of ASO following the standardized strategy were favorable, despite concerns regarding long-term adverse events. Complex TGA morphological subtypes demonstrated higher neo-ARD and composite of reoperation and re-intervention rates.
