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Comprehensive outcomes after primary arterial switch operation

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Abstract

Objective

To report the long-term outcomes of the arterial switch operation for transposition of the great arteries.

Methods

The data of 35 patients who underwent an arterial switch operation between April 2006 and May 2021 were retrospectively examined; five had double-outlet right ventricles, three had side-by-side transposition, and 27 had d-transposition. The punch-out technique was the basic method for coronary transplantation; however, if coronary artery kinking after additional peeling was a concern, the trap-door technique was used. In aortic reconstruction, the caliber difference between the neoascending aorta and the native pulmonary artery was fixed using the pulmonary artery flap. In pulmonary reconstruction, the pulmonary artery was bilaterally exposed over the second branch.

Results

The median age at operation and follow-up duration were 10.0 (8.0–12.5) days and 72.9 (40.7–139.5) months, respectively. Thirty-four patients survived, and one was lost to follow-up ([coronary transplantation]: right coronary artery, punch-out = 31, trap-door = 2; left coronary artery, punch-out = 28, trap-door = 7; [aortic regurgitation]: no–slight = 27, mild = 6, moderate = 1; [pulmonary regurgitation]: no–slight = 22, mild = 11, moderate = 1). Slight coronary bending occurred in two patients; ischemia was not observed. Catheter stent placement was performed in one of three patients with stenosis at the pulmonary artery bifurcation. Catheter balloon dilation was performed in one patient with supravalvular pulmonary stenosis. There were no cases of coronary, aortic, or pulmonary artery reoperations. The 15-year cumulative reintervention avoidance rate was 91.0%.

Conclusions

There were no deaths or reoperations during the long-term follow-up period, and arterial switch operation outcomes at our hospital were satisfactory.

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Data availability

The data that support the findings of this study are openly available.

Abbreviations

TGA:

Transposition of the great arteries

ASO:

Arterial switch operation

PS:

Pulmonary stenosis

STJ:

Sinotubular junction

PA:

Pulmonary artery

IQR:

Interquartile range

CI:

Confidence interval

AR:

Aortic regurgitation

PR:

Pulmonary regurgitation

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Authors and Affiliations

  1. Department of Pediatric Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center and Children’s Medical Center, 118-1, Arakawa, Haebaru-Cho, Okinawa, 901-1193, Japan

    Makoto Nakamura, Kazuyoshi Kanno & Masahiko Nishioka

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  1. Makoto Nakamura
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  2. Kazuyoshi Kanno
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  3. Masahiko Nishioka
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Correspondence to Makoto Nakamura.

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Conflict of interest

Makoto Nakamura, Kazuyoshi Kanno, and Masahiko Nishioka have no conflicts of interest.

IRB/ERB/EC approval

Ethical approval for the study was obtained from the Ethical Committee and Institutional Review Board Committee of the Okinawa Prefectural Nanbu Medical Center & Children’s Medical Center (approval number: R4-005).

Informed consent

Clinical data were obtained via a retrospective review of medical records; thus, the requirement for written informed consent was waived.

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Nakamura, M., Kanno, K. & Nishioka, M. Comprehensive outcomes after primary arterial switch operation. Gen Thorac Cardiovasc Surg 71, 447–454 (2023). https://doi.org/10.1007/s11748-022-01902-7

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