Sanjiv K Gandhi1, Frank A Pigula, Ralph D Siewers. 1. Department of Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh, Pennsylvania 15213-2583, USA. gandhis@heart.chp.edu
Abstract
BACKGROUND: The arterial switch operation is the therapy of choice for transposition of the great arteries. METHODS: A retrospective analysis of all children undergoing the arterial switch operation between November 1985 and October 2000 was conducted, highlighting the frequency and nature of late invasive reintervention. RESULTS: One hundred forty-four children were operated on. Operative survival was 89% (128 of 144). Late reintervention was required in 23% (29 of 128) of survivors. Neopulmonary stenosis (PS) was the most common complication requiring treatment, occurring in 16% (21 of 128) of patients. Eleven of 21 patients with PS required reoperation, whereas 10 were managed with percutaneous techniques. Other indications for reintervention included aortic arch obstruction (3 patients), ventricular septal defect (with PS in 2 patients), bronchial stenosis (2 patients), coronary stenosis (2 patients), aortic stenosis (with PS in 1 patient), and residual atrial septal defect (1 patient). There has been no mortality or major morbidity in those children who have undergone reintervention. CONCLUSIONS: Invasive reintervention after the arterial switch operation is occasionally required. The most common indication is PS. Reintervention is well tolerated by those children who require it. Continued follow-up for late complications is required in this patient population.
BACKGROUND: The arterial switch operation is the therapy of choice for transposition of the great arteries. METHODS: A retrospective analysis of all children undergoing the arterial switch operation between November 1985 and October 2000 was conducted, highlighting the frequency and nature of late invasive reintervention. RESULTS: One hundred forty-four children were operated on. Operative survival was 89% (128 of 144). Late reintervention was required in 23% (29 of 128) of survivors. Neopulmonary stenosis (PS) was the most common complication requiring treatment, occurring in 16% (21 of 128) of patients. Eleven of 21 patients with PS required reoperation, whereas 10 were managed with percutaneous techniques. Other indications for reintervention included aortic arch obstruction (3 patients), ventricular septal defect (with PS in 2 patients), bronchial stenosis (2 patients), coronary stenosis (2 patients), aortic stenosis (with PS in 1 patient), and residual atrial septal defect (1 patient). There has been no mortality or major morbidity in those children who have undergone reintervention. CONCLUSIONS: Invasive reintervention after the arterial switch operation is occasionally required. The most common indication is PS. Reintervention is well tolerated by those children who require it. Continued follow-up for late complications is required in this patient population.
Authors: Boban Thomas; José Diogo Ferreira Martins; Nuno Jalles Tavares; Artur Lopes; Fátima F Pinto; José Fragata Journal: Ann Pediatr Cardiol Date: 2013-01