Outcomes after Arterial Switch Operation for Transposition of the Great Arteries—Survival, Reoperations, Reinterventions, and Coronary Complications

Background: The arterial switch operation (ASO) is the treatment procedure of choice in patients with transposition of the great arteries (TGA). Although survival is excellent, adverse long-term sequelae are known. Especially coronary artery occlusion or stenosis are of concern. The study aimed to evaluate the long-term outcomes after ASO at a single institution with regard to survival, freedom of reoperations, and catheter interventions and frequency of coronary complications

Method: Medical records of 185 patients who underwent ASO between 2000 and 2019 were reviewed. Routine follow-up included cardiac catheterization with coronary angiography.

Results: Simple TGA was present in 112 (60.5%) patients and 73 (39.5%) had complex TGA. Median follow-up was 6.8 (IQR: 1.9–12.8) years. Early mortality was 3.2%, late mortality occurred in two patients (1.1%). Cumulative 1-, 10-, and 15-year survival was 96.7, 95.8, and 93.9%, respectively, with no difference between simple and complex TGA (p = 0.608). Reoperations or catheter interventions were performed in 45 (24.3%) patients. Rethoracotomy for bleeding (n = 27, 14.6%) was the most common cause for early reoperation (<30 days after surgery). Right ventricular outflow tract obstruction was the most common cause for late reoperation or catheter intervention (n = 17, 9.2%). Freedom from late reoperation or reintervention was 97.9, 91.5, and 85.0% at 1, 10, and 15 years for patients with simple TGA, respectively, and 87.1, 76.8, and 68.2% for complex TGA (p = 0.009), respectively. Coronary angiography performed in 150 patients (83.8% of survivors) as part of routine follow-up revealed coronary complications in 10 (6.6%) patients with complete occlusion of one coronary artery in seven cases. There was no association to the underlying coronary artery pattern. Collateral perfusion was visualized in all cases. One patient with left coronary artery occlusion suddenly died during sports at 5 years of age. Revision of coronary anastomosis during ASO (4/10 vs. 11/140, p = 0.010) and ventricular repolarization abnormalities on discharge ECG (5/10 vs. 20/140, p = 0.012) were related to coronary complications.

Conclusion: Early and longer term survival after the ASO is excellent. Reinterventions or reoperations are more common in patients with complex TGA and related to right ventricular outflow tract obstructions. Coronary artery occlusion or stenosis was rare on routine screening. Invasive coronary imaging should be reserved for patients at risk.

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Artikel online veröffentlicht:
12. Februar 2022