104. Outcomes of the Arterial Switch Operation with Aortic Arch Reconstruction
WVU Medicine Children's Hospital
Morgantown, WV
United States - Contact Me
Christopher E. Mascio, MD is Executive Director of WVU Medicine Children's Heart Center and Professor and Chief, Division of Pediatric Cardiothoracic Surgery, WVU School of Medicine in Morgantown, WV. He has been practicing for over 15 years and performs the full spectrum of congenital heart operations from neonates to adults with congenital heart disease.
Asan Medical Center
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Medical degree at Sungkyunkwan University School of Medicine, 2011, Seoul, Korea
Internship at Samsung Medical Center, 2012, Seoul, Korea
Military medical officer at Republic of Korea Army, 2012-2015
Residency (Thoracic and Cardiovascular Surgery) at Samsung Medical Center, 2019, Seoul, Korea
Fellowship (Cardiac surgery) at Samsung Medical Center, 2021, Seoul, Korea
Fellowship (Pediatric cardiac surgery) at Asan Medical Center (2021-present), Seoul, Korea
Abstract
Arterial switch operation (ASO) with aortic arch reconstruction for transposition complex associated with aortic arch obstruction remains a challenging procedure. Early mortality rate is not negligible, and late reinterventions are not uncommon after ASO with aortic arch repair. The aim of the study was to investigate midterm outcomes and factors associated with reinterventions in patients undergoing ASO and aortic arch repair.
Methods
From 2004 to 2020, 51 patients who underwent ASO and aortic arch reconstruction were included in this study. Forty-nine patients (96.1%) underwent repair primarily, and two patients (3.9%) underwent staged repair. Median follow-up duration was 59 months. Significant pulmonary stenosis (PS) was defined as peak velocity greater than 3 m/s on echocardiography.
Results
Twenty-eight patients (54.9%) had Taussig-Bing anomaly, and 23 patients (45.1%) had transposition of the great arteries with ventricular septal defect. Forty-three patients (84.3%) had coarctation of the aorta, and eight (15.7%) had interrupted aortic arch. The median age and body weight at repair was 9 days (range 4–180 days) and 3.1 kg (2.3–5.3 kg), respectively. There were five early deaths (9.8%). Late death occurred in two patients. One patient required a heart transplantation. Transplant-free survival was 86, 86 and 83% at 1, 5 and 10 years after repair, respectively. Nineteen reinterventions (13 reoperations and 6 catheter interventions) were required in 10 patients. Reintervention free survival was 74%, 66% and 63% 1, 5, and 10 years after surgery, respectively. Significant PS free survival 80%, 76% and 68% 1, 5, and 10 years after surgery, respectively (Figure). In univariable analysis, ratio of the diameters of the main pulmonary artery to the ascending aorta (great artery ratio) was associated with any reinterventions (HR, 10.5; P=.007) and right-sided reinterventions (HR, 16.1; P=.002). Aortic annulus z-score as neo-pulmonary was associated with significant PS (HR, 0.382; P=.049).
Conclusions
The overall mortality rate after ASO and aortic arch reconstruction is still considerable. Right-sided reintervention was not uncommon after ASO and aortic arch reconstruction. Ratio between the diameters of both great arteries was associated with right-sided reintervention after ASO and aortic arch reconstruction. Smaller aortic annulus z-score as neo-pulmonary was associated with the development of significant PS.