Impact of different neo-pulmonary artery surgical reconstruction techniques during the arterial switch operation on right ventricular outflow tract obstruction. A multicenter study up to 34-years' follow-up

Abstract

BackgroundRVOTO remains the most common complication after ASO in simple TGA. ObjectivesTo clarify which neo-pulmonary artery reconstruction surgical technique helps to minimize postoperative right ventricular outflow tract obstruction (RVOTO) after the arterial switch operation (ASO) for transposition of the great arteries (TGA). MethodsPatients with isolated d-TGA were identified in the German Registry for Congenital Heart Defects. ASO for isolated d-TGA at an age younger than 10 days between 1986 and 2015 at 16 centers was performed in 106 registered patients. They were divided into two groups (Group 1 - Pantaloon n = 36, Group 2-non Pantaloon n = 70) depending on the neo-pulmonary surgical reconstruction technique used during ASO. Endpoints were RVOTO development, need for reoperation or reintervention for RVOTO, and death. RVOTO was diagnosed echocardiographically. ResultsMedian follow-up was 9 (4–29) years: the pantaloon group's (group 1) cumulative follow-up was 389 patient-years and 15 (5–34) years, and the non-pantaloon group's (group 2) 1119 patient-years, p = 0.0001. We observed mild RVOTO in 56 % in group 1 and 60 % in group 2 (p-value = 0.53). Group one's moderate RVOTO (3 %) versus 9 % in group 2 (9 %) (p = 0.42). Severe RVOTO was 5 % in group one and 7 % in group two (p = 0.99). There was no difference in freedom from re-operation and survival in both groups. (log-rank p = 0,63, log-rank p = 0,25, respectively). ConclusionDevelopment of mild RVOTO is a common complication in the long-term follow-up after ASO after applying both surgical techniques. We found that both types of neo-pulmonary artery reconstruction techniques were safe in terms of developing severe RVOTO.