Vladimiro L Vida1, Lorenza Zanotto1, Lucia Zanotto2, Giovanni Stellin3, Massimo Padalino4, Georges Sarris5, Eleftherios Protopapas5, Carol Prospero6, Christian Pizarro6, Edward Woodford6, Thomas Tlaskal7, Hakan Berggren8, Martin Kostolny9, Ikenna Omeje9, Boulos Asfour10, Alexander Kadner11, Thierry Carrel11, Paul H Schoof12, Matej Nosal13, Josè Fragata14, Michał Kozłowski15, Bohdan Maruszewski15, Luca A Vricella16, Duke E Cameron16, Vladimir Sojak17, Mark Hazekamp17, Jukka Salminen18, Ilkka P Mattila18, Julie Cleuziou19, Patrick O Myers20, Viktor Hraska21. 1. Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy. 2. Department of Statistical Sciences, University of Padua, Padua, Italy. 3. Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy. Electronic address: giovanni.stellin@unipd.it. 4. Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy. 5. Athens Heart Surgery Institute and Department of Pediatric and Congenital Cardiac Surgery, Iaso Children's Hospital, Athens, Greece. 6. Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA. 7. Children's Heart Centre, University Hospital Motol, Prague, Czech Republic. 8. Department of Molecular and Clinical Medicine, Children's Heart Center, The Queen Silvia's Children's Hospital, Göteborg, Sweden. 9. Great Ormond Street Hospital, Cardiothoracic Unit, London, UK. 10. Herma Heart Center, Medical College of Wisconsin, Wisconsin, USA. 11. Department for Cardiovascular Surgery, University of Bern, Bern, Switzerland. 12. University Medical Center Utrecht, Utrecht, Netherlands. 13. Childrens Heart Centre Slovak Republic, Bratislava, Slovakia. 14. Department of Cardiothoracic Surgery, Hospital de Santa Marta and Nova Medical School, Lisbon, Portugal. 15. Children's Memorial Health Institute Varsavia, Poland. 16. Division of Cardiac Surgery, Johns Hopkins University, Baltimore, USA. 17. Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands. 18. Division of Pediatric Surgery, Department of Children and Adolescents, Helsinki University Hospital, Helsinki, Finland. 19. Department of Cardiovascular Surgery, German Heart Center Munich Technische Universität München, Munich, Germany. 20. Divison of cardiovascular Surgery, Geneva University Hospitals, Geneva, Switzerland. 21. Herma Heart Center, Medical College of Wisconsin, Milwaukee, WI, USA.
Abstract
BACKGROUND: We sought to report the frequency, types, and outcomes of left-sided reoperations (LSRs) after an arterial switch operation (ASO) for patients with D-transposition of the great arteries (D-TGA) and double-outlet right ventricle (DORV) TGA-type. METHODS: Seventeen centers belonging to the European Congenital Heart Surgeons Association (ECHSA) contributed to data collection. We included 111 patients who underwent LSRs after 7,951 ASOs (1.4%) between January 1975 and December 2010. Original diagnoses included D-TGA (n = 99) and DORV TGA-type (n = 12). Main indications for LSR were neoaortic valve insufficiency (n = 52 [47%]) and coronary artery problems (CAPs) (n = 21 [19%]). RESULTS: Median age at reoperation was 8.2 years (interquartile range [IQR], 2.9-14 years). Seven patients died early after LSRs (6.3%); 4 patients with D-TGA (5.9%) and 3 patients with DORV TGA-type (25%) (p = 0.02). Median age at last follow-up was 16.1 years (IQR, 9.9-21.8 years). Seventeen patients (16%) required another reoperation, which was more frequent in patients with DORV- TGA type (4 of 9 [45%]) than in patients with D-TGA (13 of 95 [14%]). Late death occurred in 4 patients (4 of 104 [3.8%]). The majority of survivors were asymptomatic at last clinical examination (84 of 100 [84%]). CONCLUSIONS: Reoperations for residual LSRs are infrequent but may become necessary late after an ASO, predominantly for neoaortic valve insufficiency and CAPs. Risk at reoperation is not negligible, and DORV TGA-type anatomy, as well as procedures on the coronary arteries, were significantly associated with a higher morbidity and a lower overall survival. Recurrent reoperations after LSRs may be required.
BACKGROUND: We sought to report the frequency, types, and outcomes of left-sided reoperations (LSRs) after an arterial switch operation (ASO) for patients with D-transposition of the great arteries (D-TGA) and double-outlet right ventricle (DORV) TGA-type. METHODS: Seventeen centers belonging to the European Congenital Heart Surgeons Association (ECHSA) contributed to data collection. We included 111 patients who underwent LSRs after 7,951 ASOs (1.4%) between January 1975 and December 2010. Original diagnoses included D-TGA (n = 99) and DORV TGA-type (n = 12). Main indications for LSR were neoaortic valve insufficiency (n = 52 [47%]) and coronary artery problems (CAPs) (n = 21 [19%]). RESULTS: Median age at reoperation was 8.2 years (interquartile range [IQR], 2.9-14 years). Seven patients died early after LSRs (6.3%); 4 patients with D-TGA (5.9%) and 3 patients with DORV TGA-type (25%) (p = 0.02). Median age at last follow-up was 16.1 years (IQR, 9.9-21.8 years). Seventeen patients (16%) required another reoperation, which was more frequent in patients with DORV- TGA type (4 of 9 [45%]) than in patients with D-TGA (13 of 95 [14%]). Late death occurred in 4 patients (4 of 104 [3.8%]). The majority of survivors were asymptomatic at last clinical examination (84 of 100 [84%]). CONCLUSIONS: Reoperations for residual LSRs are infrequent but may become necessary late after an ASO, predominantly for neoaortic valve insufficiency and CAPs. Risk at reoperation is not negligible, and DORV TGA-type anatomy, as well as procedures on the coronary arteries, were significantly associated with a higher morbidity and a lower overall survival. Recurrent reoperations after LSRs may be required.
Authors: Roel L F van der Palen; Teun van der Bom; Annika Dekker; Roula Tsonaka; Nan van Geloven; Irene M Kuipers; Thelma C Konings; Lukas A J Rammeloo; Arend D J Ten Harkel; Monique R M Jongbloed; Dave R Koolbergen; Barbara J M Mulder; Mark G Hazekamp; Nico A Blom Journal: Heart Date: 2019-07-10 Impact factor: 5.994
Authors: Roel L F van der Palen; Joe F Juffermans; Lucia J M Kroft; Mark G Hazekamp; Hildo J Lamb; Nico A Blom; Arno A W Roest; Jos J M Westenberg Journal: Eur J Cardiothorac Surg Date: 2021-04-29 Impact factor: 4.191