Incidence and Risk Factors for Right Ventricular Outflow Tract Obstruction after the Arterial Switch Operation

Julie Cleuziou; Keti Vitanova; Jelena Pabst von Ohain; Masamichi Ono; Daniel Tanase; Melchior Burri; Rüdiger Lange

doi:10.1055/s-0038-1645877

The Thoracic and Cardiovascular Surgeon, Table of Contents

Thorac Cardiovasc Surg 2019; 67(01): 037-043
DOI: 10.1055/s-0038-1645877

Original Cardiovascular

Georg Thieme Verlag KG Stuttgart · New York

Incidence and Risk Factors for Right Ventricular Outflow Tract Obstruction after the Arterial Switch Operation

Julie Cleuziou

¹Department of Cardiovascular Surgery, Deutsches Herzzentrum Munchen des Freistaates Bayern, Munchen, Bayern, Germany

²Institute for Translational Cardiac Surgery (INSURE), German Heart Centre Munich, Germany

,

Keti Vitanova

¹Department of Cardiovascular Surgery, Deutsches Herzzentrum Munchen des Freistaates Bayern, Munchen, Bayern, Germany

²Institute for Translational Cardiac Surgery (INSURE), German Heart Centre Munich, Germany

,

Jelena Pabst von Ohain

¹Department of Cardiovascular Surgery, Deutsches Herzzentrum Munchen des Freistaates Bayern, Munchen, Bayern, Germany

²Institute for Translational Cardiac Surgery (INSURE), German Heart Centre Munich, Germany

,

Masamichi Ono

¹Department of Cardiovascular Surgery, Deutsches Herzzentrum Munchen des Freistaates Bayern, Munchen, Bayern, Germany

²Institute for Translational Cardiac Surgery (INSURE), German Heart Centre Munich, Germany

,

Daniel Tanase

³Department of Pediatric Cardiology and Congenital Heart Defects, Deutsches Herzzentrum Munchen des Freistaates Bayern, Munchen, Bayern, Germany

,

Melchior Burri

¹Department of Cardiovascular Surgery, Deutsches Herzzentrum Munchen des Freistaates Bayern, Munchen, Bayern, Germany

²Institute for Translational Cardiac Surgery (INSURE), German Heart Centre Munich, Germany

,

Rüdiger Lange

¹Department of Cardiovascular Surgery, Deutsches Herzzentrum Munchen des Freistaates Bayern, Munchen, Bayern, Germany

²Institute for Translational Cardiac Surgery (INSURE), German Heart Centre Munich, Germany

⁴Partner site Munich Heart Alliance, Deutsches Zentrum fur Herz-Kreislauf-Forschung eV, Munich, Germany

› Author Affiliations

Abstract

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Abstract

Background The aim of this study was to evaluate the incidence and risk factors for the development of right ventricular outflow tract obstruction (RVOTO) after the arterial switch operation (ASO).

Methods Between 1983 and 2014, a total of 688 patients underwent ASO. RVOTO was defined as any obstruction of the right ventricular outflow tract (RVOT) requiring reintervention.

Results RVOTO developed in 79 patients (11%) at a median time of 3.8 years (range, 1 day–23.6 years) after ASO. Freedom from RVOT reintervention was 96 ± 1, 89 ± 1, and 83 ± 2% at 1, 10, and 25 years, respectively. Independent risk factors for the development of RVOTO in a Cox's regression model were side-by-side great arteries (p < 0.001), aortic arch anomalies (p < 0.001), use of a pericardial patch for augmentation of the coronary buttons (p < 0.001), and a peak gradient more than 20 mm Hg over the RVOT at discharge (p < 0.001).

Conclusion The incidence of RVOTO after ASO is not negligible. Complex morphology, such as side-by-side great arteries and aortic arch anomalies influences the development of RVOTO.

Keywords

neonate - right ventricular outflow tract - transposition of the great arteries

Full Text

References

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