María José Rodríguez Puras1, Luisa Cabeza-Letrán1, Manuela Romero-Vazquianez1, José Santos de Soto2, Reza Hosseinpour3, Mauro Gil Fournier4, Antonio Alvarez Madrid4, Antonio González3, Pilar Pérez1, Pastora Gallego5. 1. Unidad Intercentro de Cardiopatías Congénitas del Adulto, Área del Corazón, Hospitales Virgen del Rocío y Virgen Macarena, Sevilla, Spain. 2. Servicio de Cardiología Pediátrica, Hospital Infantil Virgen del Rocío, Sevilla, Spain. 3. Unidad Intercentro de Cardiopatías Congénitas del Adulto, Área del Corazón, Hospitales Virgen del Rocío y Virgen Macarena, Sevilla, Spain; Servicio de Cirugía Cardiaca Pediátrica, Hospital Infantil Virgen del Rocío, Sevilla, Spain. 4. Servicio de Cirugía Cardiaca Pediátrica, Hospital Infantil Virgen del Rocío, Sevilla, Spain. 5. Unidad Intercentro de Cardiopatías Congénitas del Adulto, Área del Corazón, Hospitales Virgen del Rocío y Virgen Macarena, Sevilla, Spain. Electronic address: pgallegogv@ono.com.
Abstract
INTRODUCTION AND OBJECTIVES: The arterial switch operation is currently the preferred surgical approach for complete transposition of the great arteries. We sought to determine the mid-term results of this intervention. METHODS: A single-institution retrospective review of clinical records of all consecutive patients who underwent the arterial switch surgery between 1985 and 2010. RESULTS: Overall, the operation was performed on 155 patients (68% boys) at a median age of 13 days: 64% with an intact septum, 46% with a ventricular septal defect, and 4.5% with associated aortic arch anomaly. The usual coronary pattern was found in 63%. Palliative surgery was performed prior to arterial switch in 6.5%. In all, 137 perioperative survivors were followed for a median of 6 years. Late mortality was 2.9%, of which 50% was due to coronary complications. Eighteen percent required surgical and/or percutaneous reintervention: 95.6% for right-sided obstruction and 4.3% for aortic regurgitation. At last follow-up, 92% had functional class I symptoms and 95% were free of arrhythmias. The left ventricular ejection fraction was greater than 55% in 95%, 28% had neoaortic regurgitation (78% mild regurgitation), and 31% had right ventricular outflow tract obstruction with a mean gradient according to echocardiography greater than 25mmHg. CONCLUSIONS: Mid-term survival of patients after arterial switch operation is excellent and their functional status is good. However, a few patients have residual lesions and a need for further intervention during follow-up, mostly for right-sided obstructions. Late mortality was uncommon and was related to coronary complications. Neoaortic root dilation and regurgitation are not major issues in early adulthood, but the long-term course of these lesions is still unknown.
INTRODUCTION AND OBJECTIVES: The arterial switch operation is currently the preferred surgical approach for complete transposition of the great arteries. We sought to determine the mid-term results of this intervention. METHODS: A single-institution retrospective review of clinical records of all consecutive patients who underwent the arterial switch surgery between 1985 and 2010. RESULTS: Overall, the operation was performed on 155 patients (68% boys) at a median age of 13 days: 64% with an intact septum, 46% with a ventricular septal defect, and 4.5% with associated aortic arch anomaly. The usual coronary pattern was found in 63%. Palliative surgery was performed prior to arterial switch in 6.5%. In all, 137 perioperative survivors were followed for a median of 6 years. Late mortality was 2.9%, of which 50% was due to coronary complications. Eighteen percent required surgical and/or percutaneous reintervention: 95.6% for right-sided obstruction and 4.3% for aortic regurgitation. At last follow-up, 92% had functional class I symptoms and 95% were free of arrhythmias. The left ventricular ejection fraction was greater than 55% in 95%, 28% had neoaortic regurgitation (78% mild regurgitation), and 31% had right ventricular outflow tract obstruction with a mean gradient according to echocardiography greater than 25mmHg. CONCLUSIONS: Mid-term survival of patients after arterial switch operation is excellent and their functional status is good. However, a few patients have residual lesions and a need for further intervention during follow-up, mostly for right-sided obstructions. Late mortality was uncommon and was related to coronary complications. Neoaortic root dilation and regurgitation are not major issues in early adulthood, but the long-term course of these lesions is still unknown.
Authors: Paulo H Manso; Fernando T V Amaral; Tarcísio J S Júnior; Mauro C Jurca; Jorge Haddad; Walter V A Vicente; Ricardo N Sgarbieri; Fabio Carmona Journal: Pediatr Cardiol Date: 2015-06-03 Impact factor: 1.655
Authors: Man-shik Shim; Tae-Gook Jun; Ji-Hyuk Yang; Pyo Won Park; I Seok Kang; June Huh; Jin Young Song Journal: J Cardiothorac Surg Date: 2016-02-24 Impact factor: 1.637