Surgical reinterventions after arterial switch operation for transposition of the great arteries

Abstract

Arterial switch operation has become the standard surgical treatment for transposition of the great arteries. Early and late outcomes are excellent and the focus is now on long-term outcomes. The aim of this study was to assess long-term survival of patients who had undergone arterial switch operation for transposition of the great arteries and causes of reoperation. Retrospective, single-center cohort study, including 720 patients who had undergone arterial switch operation for transposition of the great arteries, between March 1982 and April 2021. Sixty-seven patients who had reoperations were identified and divided into two groups of single ( n = 46) or ≥ 2 interventions ( n = 21). Data relative to reoperations, postoperative care, clinical and echocardiographic follow-up were collected for these 67 patients. Global survival was 87.6% for our whole cohort with a median survival of 11.9 years (4.4–19.5). There was no difference in survival between patients who had undergone reoperation and patients who had not. There was a significant difference ( P < 0.001) between patients who had arterial switch operation before 2000 (26% mortality) and those operated on afterwards (7% mortality). This significant difference ( P < 0.001) was also encountered with early mortality (21% before 2000 and 5% afterwards). Sixty-seven patients (9.3%) underwent 91 reoperations. Fifty-five percent of those were on pulmonary outflow tract. At the end of the follow-up, 3.7% of reoperated patients suffered from left ventricular dysfunction and 60% had aortic insufficiency from mild (25 patients) to moderate (8 patients) ( Fig. 1 ). Arterial switch operation is a true success in the surgical management of transposition of the great arteries. Mortality is decreasing with improvement of techniques and perioperative management. Reoperation rate is rather low and does not seem to have an influence on survival.