Outcomes of the Arterial Switch Operation in Patients With Concomitant Aortic Arch Obstruction as a Single Stage Repair

Abstract

Purpose: We sought to determine outcomes of patients who underwent arterial switch operation (ASO) with concomitant aortic arch obstruction (AAO) repair as a single stage procedure. Methodology: All patients who underwent an ASO since 2008 were identified from a single institution's database and reviewed retrospectively. Aortic arch obstruction was defined as coarctation of the aorta, hypoplastic aortic arch or interrupted aortic arch. Results: From 1983 to 2008, 666 patients underwent an ASO for biventricular repair at our institution. Sixty-three (9.5%, 63/666) patients who underwent ASO had AAO. Thirty-five (55%, 35/63) patients had AAO repair at time of ASO as part of a single stage repair. Of these 35, twenty-one (60%, 21/35) had transposition of the great arteries and 14 (40%, 14/35) had Taussig-Bing anomaly. There were 2 (5.7%, 2/35) hospital deaths in these patients compared to an overall hospital mortality of 2.9% (19/666). No patients required reoperation during hospital admission. Follow-up was available for 32 (97%, 32/33) survivors. Mean follow-up was 11.2 years (range 7 months to 31 years). There were no late deaths. Three (9.4%, 3/32) patients required 4 late reoperations. Two (6.3%, 2/32) patients had moderate neo-aortic valve regurgitation (AR) at last follow-up. Two (6.3%, 2/32) patients required neo-aortic root valve replacement for severe AR. All survivors were in New York Heart Association Class I at last follow-up. Conclusion: Patients who go undergo ASO with associated AAO as a single stage repair have good early outcomes. Excellent survival and a low reoperation rate continues into adolescence and young adulthood. Close follow-up of neo-aortic valvular regurgitation is warranted.