Long-term outcomes after the arterial switch operation for D-transposition of the great arteries – a single centre experience
DOI:
https://doi.org/10.6016/ZdravVestn.3223Keywords:
transposition of great arteries, arterial switch operation, late complicationsAbstract
Background: Arterial switch operation (ASO) is the treatment of choice for D-transposition of great arteries (D-TGA). The purpose of the study was to evaluate the long-term outcome after ASO.
Methods: We either retrospectively reviewed the documentation or reassessed 38 patients (30 men, 8 women) during the transition period from adolescence to adulthood (age at the last clinical examination 17.1 ± 1.4 years) born from 2000 until 2005 with D-TGA and performed early ASO. We assessed: NYHA functional class, residual changes in neoaorta and neoaortic valve, neopulmonary valve, and pulmonary arteries, right and left ventricular function, physical performance, and signs of myocardial ischaemia.
Results: There was no mortality confidence interval (0.00-0.09). Thirty-two patients (84.2%) were in NYHA class I, and 6 patients (15.7%) were in NYHA class II. In 83.3% of patients, the aortic root was dilated (20.9 ± 2.8 mm/m2, max. 27.7 mm/m2). Neoaortic valve regurgitation was present in 27 patients (90%). There were no differences in bulbus width normalized to body surface area between groups without, mild or moderate neoaortic regurgitation (p = 0.6). Neopulmonary valve regurgitation was present in 58.1%. Due to an obstruction in the right ventricular outflow at any level, reoperation was required in one case and percutaneous dilatation of the neopulmonary valve in 1 case. Due to coronary artery complications, surgery was required only in one case because of myocardial infarction during exertion.
Conclusion: Late results after complete correction in patients with D-TGA are good and comparable to larger centres. There was no mortality; most patients were asymptomatic, with normal systolic function of both ventricles and normal physical performance. Reoperations and percutaneous procedures were quite rare and successful in the long run.
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References
1. Brickner ME, Hillis LD, Lange RA. Congenital heart disease in adults. Second of two parts. N Engl J Med. 2000;342(5):334-42.
DOI: 10.1056/NEJM200002033420507
PMID: 10655533
2. Senning A. Surgical correction of transposition of the great vessels. Surgery. 1959;45(6):966-80.
PMID: 13659340
3. Mustard WT. Successful two-stage correction of transposition of the great vessels. Surgery. 1964;55:469-72.
PMID: 14133108
4. Jatene AD, Fontes VF, Paulista PP, Souza LC, Neger F, Galantier M, et al. Anatomic correction of transposition of the great vessels. J Thorac Cardiovasc Surg. 1976;72(3):364-70.
DOI: 10.1016/S0022-5223(19)40063-9
PMID: 957754
5. Lecompte Y, Zannini L, Hazan E, Jarreau MM, Bex JP, Tu TV, et al. Anatomic correction of transposition of the great arteries. J Thorac Cardiovasc Surg. 1981;82(4):629-31.
DOI: 10.1016/S0022-5223(19)39303-1
PMID: 7278356
6. Kirzner J, Pirmohamed A, Ginns J, Singh HS. Long-term management of the arterial switch patient. Curr Cardiol Rep. 2018;20(8):68.
DOI: 10.1007/s11886-018-1012-9
PMID: 29946937
7. Sarris GE, Balmer C, Bonou P, Comas JV, da Cruz E, Chiara LD, et al. Clinical guidelines for the management of patients with transposition of the great arteries with intact ventricular septum. Eur J Cardiothorac Surg. 2017;51(1):e1-32.
DOI: 10.1093/ejcts/ezw360
PMID: 28077506
8. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233-70.
DOI: 10.1093/ehjci/jev014
PMID: 25712077
9. Long J, Ramadhani T, Mitchell LE. Epidemiology of nonsyndromic conotruncal heart defects in Texas, 1999-2004. Birth Defects Res A Clin Mol Teratol. 2010;88(11):971-9.
DOI: 10.1002/bdra.20724
PMID: 20878913
10. Bianca S, Ettore G. Sex ratio imbalance in transposition of the great arteries and possible agricultural environmental risk factors. Images Paediatr Cardiol. 2001;3(3):10-4.
PMID: 22368601
11. Tutarel O, Ramlakhan KP, Baris L, Subirana MT, Bouchardy J, Nemes A, et al.; ROPAC (Registry of Pregnancy and Cardiac Disease) Investigators Group. Pregnancy outcomes in women after arterial switch operation for transposition of the great arteries: Results From ROPAC (Registry of Pregnancy and Cardiac Disease) of the European Society of Cardiology EURObservational Research Programme. J Am Heart Assoc. 2021;10(1):e018176.
DOI: 10.1161/JAHA.120.018176
PMID: 33350866
12. Vida VL, Zanotto L, Zanotto L, Triglia LT, Bellanti E, Castaldi B, et al. Arterial switch operation for transposition of the great arteries: A single-centre 32-year experience. J Card Surg. 2019;34(11):1154-61.
DOI: 10.1111/jocs.14045
PMID: 31508848
13. Khairy P, Clair M, Fernandes SM, Blume ED, Powell AJ, Newburger JW, et al. Cardiovascular outcomes after the arterial switch operation for D-transposition of the great arteries. Circulation. 2013;127(3):331-9.
DOI: 10.1161/CIRCULATIONAHA.112.135046
PMID: 23239839
14. Villafañe J, Lantin-Hermoso MR, Bhatt AB, Tweddell JS, Geva T, Nathan M, et al.; American College of Cardiology’s Adult Congenital and Pediatric Cardiology Council. D-transposition of the great arteries: the current era of the arterial switch operation. J Am Coll Cardiol. 2014;64(5):498-511.
DOI: 10.1016/j.jacc.2014.06.1150
PMID: 25082585
15. Marino BS, Wernovsky G, McElhinney DB, Jawad A, Kreb DL, Mantel SF, et al. Neo-aortic valvar function after the arterial switch. Cardiol Young. 2006;16(5):481-9.
DOI: 10.1017/S1047951106000953
PMID: 16984700
16. McMahon CJ, Ravekes WJ, Smith EO, Denfield SW, Pignatelli RH, Altman CA, et al. Risk factors for neo-aortic root enlargement and aortic regurgitation following arterial switch operation. Pediatr Cardiol. 2004;25(4):329-35.
DOI: 10.1007/s00246-003-0483-6
PMID: 14727099
17. Schwartz ML, Gauvreau K, del Nido P, Mayer JE, Colan SD. Long-term predictors of aortic root dilation and aortic regurgitation after arterial switch operation. Cirulation. 2004;110(11 Suppl 1):II128-32.
DOI: 10.1161/01.CIR.0000138392.68841.d3
PMID: 15364851
18. Hutter PA, Thomeer BJ, Jansen P, Hitchcock JF, Faber JA, Meijboom EJ, et al. Fate of the aortic root after arterial switch operation. Eur J Cardiothorac Surg. 2001;20(1):82-8.
DOI: 10.1016/S1010-7940(01)00752-7
PMID: 11423279
19. Delmo Walter EM, Huebler M, Alexi-Meshkishvili V, Sill B, Berger F, Hetzer R. Fate of the aortic valve following the arterial switch operation. J Card Surg. 2010;25(6):730-6.
DOI: 10.1111/j.1540-8191.2010.01144.x
PMID: 21044157
20. Freed DH, Robertson CM, Sauve RS, Joffe AR, Rebeyka IM, Ross DB, et al.; Western Canadian Complex Pediatric Therapies Project Follow-up Group. Intermediate-term outcomes of the arterial switch operation for transposition of great arteries in neonates: alive but well? J Thorac Cardiovasc Surg. 2006;132(4):845-52.
DOI: 10.1016/j.jtcvs.2006.05.046
PMID: 17000296
21. Di Salvo G, Al Bulbul ZA, Issa Z, Fadel B, Al-Sehly A, Pergola V, et al. Left ventricular mechanics after arterial switch operation: a speckle-tracking echocardiography study J Cardiovasc Med (Hagerstown) 2016;17(3):217-24. J Cardiovasc Med (Hagerstown). 2016;17(3):217-24.
DOI: 10.2459/JCM.0000000000000316
PMID: 26825330
22. Michalak KW, Sobczak-Budlewska K, Moll JJ, Szymczyk K, Moll JA, Niwald M, et al. Can we predict potentially dangerous coronary patterns in patients with transposition of the great arteries after an arterial switch operation? Cardiol Young. 2019;29(11):1350-5.
DOI: 10.1017/S104795111900204X
PMID: 31507258
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