Left-Sided Reoperations After Arterial Switch Operation: A European Multicenter Study.
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Vida Vladimiro L, Zanotto Lorenza, Zanotto Lucia, Stellin Giovanni, European Congenital Heart Surgeons Association (ECHSA) Study Group, Padalino Massimo, Sarris Georges, Protopapas Eleftherios, Prospero Carol, Pizarro Christian, Woodford Edward, Tlaskal Thomas, Berggren Hakan, Kostolny Martin, Omeje Ikenna, Asfour Boulos, Kadner Alexander, Carrel Thierry, Schoof Paul H, Nosal Matej, Fragata Josè, Kozłowski Michał, Maruszewski Bohdan, Vricella Luca A, Cameron Duke E, Sojak Vladimir, Hazekamp Mark, Salminen Jukka, Mattila Ilkka P, Cleuziou Julie, Myers Patrick O, Hraska Viktor
Аннотация
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.