Current expectations of the arterial switch operation in a small volume center: a 20-year, single-center experience.

Man-Shik Shim,Ji-Hyuk Yang,I Seok Kang,June Huh,Jin Young Song,Tae-Gook Jun,Pyo Won Park

doi:10.1186/s13019-016-0428-9

Man-Shik Shim, Ji-Hyuk Yang + Show 5 more

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https://doi.org/10.1186/s13019-016-0428-9

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Abstract

BackgroundWe reviewed our 20-year experience with arterial switch operation (ASO) for transposition of the great arteries (TGA) or double outlet right ventricle with subpulmonary ventricular septal defect (Taussig-Bing anomaly) to assess the early and long-term outcomes.MethodsBetween January 1995 and December 2014, 139 consecutive patients who underwent ASO for TGA or Taussig-Bing anomaly were included in this retrospective study. The median age at the operation was 9 (0–485) days, and 97 patients (70 %) underwent ASO less than 2 weeks. The median weight was 3.3 (2.1-10.3) kg. The patients were divided into three groups; simple TGA (n = 78) included patients with TGA with intact ventricular septum, complex TGA (n = 46) included those who had TGA with ventricular septal defect or other anomalies, and Taussig-Bing anomaly (n = 15). Median follow-up duration was 72.5 (0.4-230) months.ResultsThere were 3(2.2 %) in-hospital deaths. One patient (0.7 %) underwent early reoperation due to coronary insufficiency. Late deaths occurred in 3 (2.2 %) of 136 survivors. The Kaplan-Meier’s survival rate was 97.6 ± 1.4 % at 15 years. Twenty-three patients (16.9 %) required 26 reintervention. The freedom from reintervention rates were 82.5 ± 3.7 % at 5 years and 75.8 ± 4.7 % at 10 years, respectively. Median interval between ASO and first reintervention was 22.8 (6.4-89.2) months. The multivariate analysis showed that diagnosis of Taussig-Bing anomaly (hazard ratio, 7.09; P < 0.001) and side by side great artery relationship (hazard ratio, 7.98; P = 0.001) were independent risk factors for reoperation. Five patients (3.9 %) had developed at least moderate neo-aortic regurgitation during the follow-up and one patient underwent reoperation mainly for neo-aortic regurgitation. By multivariate analysis, Taussig-Bing anomaly was the risk factor for at least moderate neo-aortic regurgitation (P = 0.035).ConclusionsASO can be performed with a low risk of early mortality and satisfactory long-term outcomes even in a small volume center. Close long-term surveillance is mandatory to detect structural or hemodynamic changes.

Highlights

We reviewed our 20-year experience with arterial switch operation (ASO) for transposition of the great arteries (TGA) or double outlet right ventricle with subpulmonary ventricular septal defect (Taussig-Bing anomaly) to assess the early and long-term outcomes
The complex TGA group (n = 46) included those who had d-TGA with a ventricular septal defect (VSD) or other anomalies such as coarctation of the aorta, interrupted aortic arch, total anomalous pulmonary venous return, significant left ventricular outflow tract (LVOT) obstruction, and those who had l-TGA with situs inversus
The second who had TGA with large VSD underwent the ASO at 61 days old due to delayed diagnosis

Summary

Introduction

We reviewed our 20-year experience with arterial switch operation (ASO) for transposition of the great arteries (TGA) or double outlet right ventricle with subpulmonary ventricular septal defect (Taussig-Bing anomaly) to assess the early and long-term outcomes. The arterial switch operation (ASO) has become the procedure of choice for the transposition of great arteries (TGA) and double outlet right ventricle (DORV) with subpulmonary ventricular septal defect (VSD) (Taussig– Bing anomaly, TBA). This report focuses on the short- and midterm results according to the anatomic subtype and surgical techniques. It intends to determine the current risk factors for mortality and morbidity

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