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Updated: Mar 16, 2026
Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Durability of the Arterial Switch Operation: Long-Term Survival and Structural Sequelae in a Multicentre Cohort
Hwa Jin Cho1, Se Yong Jung2, Hyun Chung3
1Department of Pediatrics, Chonnam National University Children's Hospital and Medical School, Gwangju, Republic of Korea.
Background:
The arterial switch operation (ASO) is the standard repair for complete transposition of the great arteries (TGA), but long-term data across large contemporary cohorts remain limited. In this study we evaluated 30-year survival, reintervention, and structural sequelae after ASO and identified factors that influenced late outcomes.
Methods:
A total of 1125 patients, 652 with TGA with intact ventricular septum, 389 with TGA with ventricular septal defect, and 84 with double-outlet right ventricle with Taussig-Bing anomaly who underwent ASO between 1990 and 2015 at 10 tertiary centres were retrospectively reviewed. Kaplan-Meier and Cox regression analyses were used to assess survival and predictors of late mortality.
Results:
Survival was 91.3%, 90.7%, and 88.9% at 10, 20, and 30 years, respectively. Patients with double-outlet right ventricle with Taussig-Bing anomaly had the lowest 30-year survival (74.6%; P < 0.001). Postoperative mechanical circulatory support, reoperation during the index hospitalization, and complete atrioventricular block requiring pacemaker were independent predictors of late mortality. The presence of arch anomalies (such as coarctation or interruption of the aorta) was identified as the only independent predictor of late reintervention (subdistribution hazard ratio, 2.507; 95% confidence interval, 1.429-4.398; P = 0.001). Reintervention occurred in 17% (341 procedures), most commonly for right ventricular outflow or pulmonary artery obstruction (12%). Coronary complications occurred in 2.8%, and 2% required reintervention. Neoaortic root dilation (z ≥ 4) developed in 18%, typically beyond the first decade.
Conclusions:
The ASO provides durable survival and excellent long-term functional outcomes extending beyond 3 decades. Right-sided reintervention remains the most frequent late event, whereas progressive neoaortic dilation and regurgitation represent the dominant late burden. Coronary failures are now rare, confirming the durability of modern coronary transfer techniques and underscoring the importance of lifelong, structured surveillance.
