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Cedars A, Jacobs ML, Gottlieb-Sen D, Jacobs JP, Alejo D, Habib RH, Parsons N, Tompkins BA, Mettler B. Reoperations in Adolescents and Adults After Prior Arterial Switch Operation: The Society of Thoracic Surgeons Congenital Heart Surgery Database Analysis. Ann Thorac Surg 2024:S0003-4975(24)00468-5. [PMID: 38878952 DOI: 10.1016/j.athoracsur.2024.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/18/2024] [Accepted: 05/13/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND Arterial switch operation (ASO) has supplanted physiologic repairs for transposition of the great arteries and related anomalies. As survival rates have increased, so has the potential need for cardiac reoperations to address ASO-related complications arising later in life. METHODS The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010-2021) was reviewed to assess prevalence and types of cardiac reoperations for patients aged ≥10 years with prior ASO for transposition of the great arteries or double-outlet right ventricle/transposition of the great arteries type. A hierarchical stratification designating 13 procedure categories was established a priori by investigators. Each eligible surgical hospitalization was assigned to the single highest applicable hierarchical category. Outcomes were compared across procedure categories, excluding hospitalizations limited to pacemaker-only and mechanical circulatory support-only procedures. Variation during the study period in relative proportions of left heart vs non-left heart procedure category encounters was assessed. RESULTS There were 698 cardiac surgical hospitalizations for patients aged 10 to 35 years at 100 centers. The most common left heart procedure categories were aortic valve procedures (n = 146), aortic root procedures (n = 117), and coronary artery procedures (n = 40). Of 619 hospitalizations eligible for outcomes analysis, major complications occurred in 11% (67/619). Discharge mortality was 2.3% (14/619). Year-by-year analysis of surgical hospitalizations reveals substantial growth in numbers for the aggregate of all procedure categories. Growth in relative proportions of left heart vs non-left heart procedures was significant (P = .0029; Cochran-Armitage trend test). CONCLUSIONS This large multicenter study of post-ASO reoperations beyond early childhood documents year-over-year growth in total reoperations. Left-sided heart procedures recently had the highest rate of rise. These observations have implications for counseling, surveillance, and management.
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Affiliation(s)
- Ari Cedars
- Division of Cardiology, Department of Internal Medicine, Johns Hopkins University, Baltimore, Maryland.
| | - Marshall L Jacobs
- Division of Cardiothoracic Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Danielle Gottlieb-Sen
- Division of Cardiothoracic Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Jeffrey P Jacobs
- Division of Cardiothoracic Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | - Diane Alejo
- Division of Cardiothoracic Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Robert H Habib
- The Society of Thoracic Surgeons Research and Analytic Center, Chicago, Illinois
| | - Niharika Parsons
- The Society of Thoracic Surgeons Research and Analytic Center, Chicago, Illinois
| | - Bryon A Tompkins
- Division of Cardiothoracic Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Bret Mettler
- Division of Cardiothoracic Surgery, Department of Surgery, Johns Hopkins University, Baltimore, Maryland
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Lee S, Kim CH, Lee JH, Kwak JG. Valve-Sparing Neo-Aortic Root Replacement for Neo-Aortic Root Dilatation 20 Years after Arterial Switch Operation for Transposition of the Great Arteries: A Case Report. J Chest Surg 2023; 56:445-448. [PMID: 37574885 PMCID: PMC10625968 DOI: 10.5090/jcs.23.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Abstract
A 25-year-old man returned to Seoul National University Children's Hospital with mild dyspnea on exertion. He had undergone an arterial switch operation at 1 month after birth to correct a complete transposition of the great arteries and a ventricular septal defect. When the patient was 15 years old, dilatation of the neo-aortic sinus and annulus was first identified; since then, it had gradually increased. Given the young age of the patient and the degree of aortic regurgitation (AR), which was mild to moderate, we opted to perform a valve-sparing neo-aortic root replacement with aortic valve repair. Postoperative echocardiography showed successful reductions in the sizes of the aortic sinus and annulus, with only mild AR remaining.
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Affiliation(s)
- Sangjun Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chan Hyeong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Hong Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Gun Kwak
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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3
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Sasikumar N, Alawani S, Sudhakar A, Kumar RK. Simultaneous Double Balloon Dilatation for Supravalvar Pulmonary Obstruction After Arterial Switch Operation. Pediatr Cardiol 2023:10.1007/s00246-023-03288-6. [PMID: 37697169 DOI: 10.1007/s00246-023-03288-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/25/2023] [Indexed: 09/13/2023]
Abstract
The optimal approach for supravalvar right ventricular outflow tract obstruction(RVOTO) after arterial switch operation(ASO) is unclear. The results of percutaneous balloon dilatation have been variable. We report the results of simultaneous double balloon dilation for RVOTO after ASO. Sixteen patients (1.3(0.7-3.8) years; 9.8(8.1-15.1) kgs underwent the procedure at 14(8-44.5) months after ASO. Salient technical features included placement of balloons over stiff guide-wires positioned in both branch pulmonary arteries to enable dilation of the distal-most main pulmonary artery (MPA) with high inflation pressures (~ 12-14 atmospheres) and short inflation-deflation cycles. Effective balloon size was based on the PA annulus or MPA distal to the narrowing. The final balloon: narrowest segment diameter ratio was 2.7. Following dilation, the right ventricle to systemic systolic pressure ratio decreased from 0.9 ± 0.18 to 0.52 ± 0.16 (p < 0.001) and mean RVOT gradient from 78 ± 18 to 34 ± 13.9 mmHg (p < 0.001). Narrowest diameter improved from 5.4 ± 2.2 to 9.2 ± 2.2 mm. There were no major complications. Two patients with inadequate relief (final RV-systemic ratios: 1.03 and 0.7) were referred for surgery. At median follow up of 9 months, IQR 7-22, range 5-73, others are free of re interventions with median RVOT gradient of 42, IQR 27-49, range 21-55 mmHg. The immediate and short-term follow up results of double balloon dilatation for supravalvar RVOTO is encouraging and may avoid the need for repeat surgery in the majority of patients. Further follow up is needed to determine the long-term durability of the results.
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Affiliation(s)
- Navaneetha Sasikumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, 682041, India.
| | - Sujata Alawani
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, 682041, India
| | - Abish Sudhakar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, 682041, India
| | - Raman Krishna Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, 682041, India
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4
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Hongu H, Oda S, Maeda Y, Asada S, Fujita S, Yamashita E, Nagase T, Yamagishi M. A new predictor of the optimal pulmonary artery reconstruction method during the arterial switch operation. Eur J Cardiothorac Surg 2023; 64:ezad173. [PMID: 37140552 DOI: 10.1093/ejcts/ezad173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/20/2023] [Accepted: 04/18/2023] [Indexed: 05/05/2023] Open
Abstract
OBJECTIVES The aim of this study was to more accurately predict the optimal pulmonary artery (PA) reconstruction procedure (Lecompte manoeuvre or original Jatene procedure) during the arterial switch operation, we focused on the horizontal sectioning (HS) angle between the left hilum PA and the great arteries using preoperative computed tomography imaging. METHODS We defined the HS angle α (β) as the angle between the tangential line from the posterior (anterior) wall of the left PA at the hilum to the left anterior (right posterior) surface of the main PA and the tangential line from the left surface of the ascending aorta to the left anterior (right posterior) surface of the main PA. We identified 14 consecutive patients diagnosed with transposition of the great arteries or transposition of the great artery-type double-outlet right ventricle who underwent preoperative computed tomography imaging. The original Jatene or Lecompte procedure was used for 9 (OJ group) and 5 (L group) patients. Relationships of the great arteries of the OJ and L groups were side by side in 8 and 2 patients, oblique in 1 and 1 patient and anteroposterior in 0 and 2 patients, respectively. RESULTS In the OJ group, β was greater than α in all patients. The median α/β value was 0.618. In group L, α was greater than β in all patients. The median α/β was 1.307. Left PA stenosis caused by stretching was not observed in the L group. Coronary obstruction was not identified in the OJ group. Left PA stenosis behind the neo-ascending aorta was observed in 1 patient in the OJ group and required reoperation. CONCLUSIONS The HS angle may be a useful predictor of optimal intraoperative PA reconstruction during arterial switch operation, especially for side-by-side or oblique relationships.
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Affiliation(s)
- Hisayuki Hongu
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shinichiro Oda
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshinobu Maeda
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Asada
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shuhei Fujita
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eijiro Yamashita
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takashi Nagase
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaaki Yamagishi
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
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5
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Ayala R, Dudakova M, Reeg H, Bauer U, Stiller B, Kubicki R, Kari FA. Impact of different neo-pulmonary artery surgical reconstruction techniques during the arterial switch operation on right ventricular outflow tract obstruction. A multicenter study up to 34-years' follow-up. PROGRESS IN PEDIATRIC CARDIOLOGY 2023. [DOI: 10.1016/j.ppedcard.2023.101638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Tseng SY, Tretter JT, Gao Z, Ollberding NJ, Lang SM. Aortic root rotational position associates with aortic valvar incompetence and aortic dilation after arterial switch operation for transposition of the great arteries. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:1013-1021. [PMID: 36809390 DOI: 10.1007/s10554-023-02794-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 01/02/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE Aortic dilation and valvar regurgitation can develop in transposition of the great arteries (TGA) after the arterial switch operation (ASO). Variation in aortic root rotational position affects flow dynamics in patients without congenital heart disease. The aim of this study was to assess neo-aortic root (neo-AoR) rotational position and its association with neo-AoR dilation, ascending aorta (AAo) dilation, and neo-aortic valvar regurgitation in TGA following ASO. METHODS Patients with TGA repaired by ASO who underwent cardiac magnetic resonance (CMR) were reviewed. Neo-AoR rotational angle, neo-AoR and AAo dimensions indexed (to height), indexed left ventricular end diastolic volume (LVEDVI), and neo-aortic valvar regurgitant fraction (RF) were obtained from CMR. RESULTS Among 36 patients, the median age at CMR was 17.1 years (12.3, 21.9). Neo-AoR rotational angle (range - 52 to + 78°) was clockwise ( ≥ + 15°) in 50%, counterclockwise (<-9°) in 25%, and central (-9 to + 14°) in 25% of patients. A quadratic term for neo-AoR rotational angle, indicating increasing extremes of counterclockwise and clockwise angles, was associated with neo-AoR dilation (R2 = 0.132, p = 0.03), AAo dilation (R2 = 0.160, p = 0.016), and LVEDVI (R2 = 0.20, p = 0.007). These associations remained statistically significant on multivariable analyses. Rotational angle was negatively associated with neo-aortic valvar RF on univariable (p < 0.05) and multivariable analyses (p < 0.02). Rotational angle was associated with smaller bilateral branch pulmonary arteries (p = 0.02). CONCLUSION In patients with TGA after ASO, neo-AoR rotational position likely affects valvar function and hemodynamics, leading to a risk of neo-AoR and AAo dilation, aortic valvar incompetence, increasing left ventricular size, and smaller branch pulmonary arteries.
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Affiliation(s)
- Stephanie Y Tseng
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. .,The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Justin T Tretter
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatric Cardiology, The Heart, Vascular, and Thoracic Institute, Cleveland Clinic Children's, Cleveland Clinic, Cleveland, OH, USA
| | - Zhiqian Gao
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nicholas J Ollberding
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sean M Lang
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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7
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Nakamura M, Kanno K, Nishioka M. Comprehensive outcomes after primary arterial switch operation. Gen Thorac Cardiovasc Surg 2022:10.1007/s11748-022-01902-7. [PMID: 36583825 DOI: 10.1007/s11748-022-01902-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To report the long-term outcomes of the arterial switch operation for transposition of the great arteries. METHODS The data of 35 patients who underwent an arterial switch operation between April 2006 and May 2021 were retrospectively examined; five had double-outlet right ventricles, three had side-by-side transposition, and 27 had d-transposition. The punch-out technique was the basic method for coronary transplantation; however, if coronary artery kinking after additional peeling was a concern, the trap-door technique was used. In aortic reconstruction, the caliber difference between the neoascending aorta and the native pulmonary artery was fixed using the pulmonary artery flap. In pulmonary reconstruction, the pulmonary artery was bilaterally exposed over the second branch. RESULTS The median age at operation and follow-up duration were 10.0 (8.0-12.5) days and 72.9 (40.7-139.5) months, respectively. Thirty-four patients survived, and one was lost to follow-up ([coronary transplantation]: right coronary artery, punch-out = 31, trap-door = 2; left coronary artery, punch-out = 28, trap-door = 7; [aortic regurgitation]: no-slight = 27, mild = 6, moderate = 1; [pulmonary regurgitation]: no-slight = 22, mild = 11, moderate = 1). Slight coronary bending occurred in two patients; ischemia was not observed. Catheter stent placement was performed in one of three patients with stenosis at the pulmonary artery bifurcation. Catheter balloon dilation was performed in one patient with supravalvular pulmonary stenosis. There were no cases of coronary, aortic, or pulmonary artery reoperations. The 15-year cumulative reintervention avoidance rate was 91.0%. CONCLUSIONS There were no deaths or reoperations during the long-term follow-up period, and arterial switch operation outcomes at our hospital were satisfactory.
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Affiliation(s)
- Makoto Nakamura
- Department of Pediatric Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, 118-1, Arakawa, Haebaru-Cho, Okinawa, 901-1193, Japan.
| | - Kazuyoshi Kanno
- Department of Pediatric Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, 118-1, Arakawa, Haebaru-Cho, Okinawa, 901-1193, Japan
| | - Masahiko Nishioka
- Department of Pediatric Cardiovascular Surgery, Okinawa Prefectural Nanbu Medical Center and Children's Medical Center, 118-1, Arakawa, Haebaru-Cho, Okinawa, 901-1193, Japan
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8
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Wang Z, Li Z, Ding N, Yi H, Zhu Y, Yan D, Li X, Bai S. Incidence and risk factors for late complications after the arterial switch operation. J Card Surg 2022; 37:3117-3132. [PMID: 35790026 DOI: 10.1111/jocs.16745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/08/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Zhangwei Wang
- Department of Cardiac Surgery, National Children's Medical Center, Beijing Children's Hospital Capital Medical University Beijing China
| | - Zhiqiang Li
- Department of Cardiac Surgery, National Children's Medical Center, Beijing Children's Hospital Capital Medical University Beijing China
| | - Nan Ding
- Department of Cardiac Surgery, National Children's Medical Center, Beijing Children's Hospital Capital Medical University Beijing China
| | - Hanlu Yi
- Department of Cardiac Surgery, National Children's Medical Center, Beijing Children's Hospital Capital Medical University Beijing China
| | - Yaobin Zhu
- Department of Cardiac Surgery, National Children's Medical Center, Beijing Children's Hospital Capital Medical University Beijing China
| | - Daole Yan
- Department of Cardiac Surgery, National Children's Medical Center, Beijing Children's Hospital Capital Medical University Beijing China
| | - Xiaofeng Li
- Department of Cardiac Surgery, National Children's Medical Center, Beijing Children's Hospital Capital Medical University Beijing China
| | - Song Bai
- Department of Cardiac Surgery, National Children's Medical Center, Beijing Children's Hospital Capital Medical University Beijing China
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Fogel MA, Anwar S, Broberg C, Browne L, Chung T, Johnson T, Muthurangu V, Taylor M, Valsangiacomo-Buechel E, Wilhelm C. Society for Cardiovascular Magnetic Resonance/European Society of Cardiovascular Imaging/American Society of Echocardiography/Society for Pediatric Radiology/North American Society for Cardiovascular Imaging Guidelines for the use of cardiovascular magnetic resonance in pediatric congenital and acquired heart disease : Endorsed by The American Heart Association. J Cardiovasc Magn Reson 2022; 24:37. [PMID: 35725473 PMCID: PMC9210755 DOI: 10.1186/s12968-022-00843-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) has been utilized in the management and care of pediatric patients for nearly 40 years. It has evolved to become an invaluable tool in the assessment of the littlest of hearts for diagnosis, pre-interventional management and follow-up care. Although mentioned in a number of consensus and guidelines documents, an up-to-date, large, stand-alone guidance work for the use of CMR in pediatric congenital 36 and acquired 35 heart disease endorsed by numerous Societies involved in the care of these children is lacking. This guidelines document outlines the use of CMR in this patient population for a significant number of heart lesions in this age group and although admittedly, is not an exhaustive treatment, it does deal with an expansive list of many common clinical issues encountered in daily practice.
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Affiliation(s)
- Mark A Fogel
- Departments of Pediatrics (Cardiology) and Radiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Shaftkat Anwar
- Department of Pediatrics (Cardiology) and Radiology, The University of California-San Francisco School of Medicine, San Francisco, USA
| | - Craig Broberg
- Division of Cardiovascular Medicine, Oregon Health and Sciences University, Portland, USA
| | - Lorna Browne
- Department of Radiology, University of Colorado, Denver, USA
| | - Taylor Chung
- Department of Radiology and Biomedical Imaging, The University of California-San Francisco School of Medicine, San Francisco, USA
| | - Tiffanie Johnson
- Department of Pediatrics (Cardiology), Indiana University School of Medicine, Indianapolis, USA
| | - Vivek Muthurangu
- Department of Pediatrics (Cardiology), University College London, London, UK
| | - Michael Taylor
- Department of Pediatrics (Cardiology), University of Cincinnati School of Medicine, Cincinnati, USA
| | | | - Carolyn Wilhelm
- Department of Pediatrics (Cardiology), University Hospitals-Cleveland, Cleaveland, USA
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10
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Fogel MA, Anwar S, Broberg C, Browne L, Chung T, Johnson T, Muthurangu V, Taylor M, Valsangiacomo-Buechel E, Wilhelm C. Society for Cardiovascular Magnetic Resonance/European Society of Cardiovascular Imaging/American Society of Echocardiography/Society for Pediatric Radiology/North American Society for Cardiovascular Imaging Guidelines for the Use of Cardiac Magnetic Resonance in Pediatric Congenital and Acquired Heart Disease: Endorsed by The American Heart Association. Circ Cardiovasc Imaging 2022; 15:e014415. [PMID: 35727874 PMCID: PMC9213089 DOI: 10.1161/circimaging.122.014415] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Cardiovascular magnetic resonance has been utilized in the management and care of pediatric patients for nearly 40 years. It has evolved to become an invaluable tool in the assessment of the littlest of hearts for diagnosis, pre-interventional management and follow-up care. Although mentioned in a number of consensus and guidelines documents, an up-to-date, large, stand-alone guidance work for the use of cardiovascular magnetic resonance in pediatric congenital 36 and acquired 35 heart disease endorsed by numerous Societies involved in the care of these children is lacking. This guidelines document outlines the use of cardiovascular magnetic resonance in this patient population for a significant number of heart lesions in this age group and although admittedly, is not an exhaustive treatment, it does deal with an expansive list of many common clinical issues encountered in daily practice.
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Affiliation(s)
- Mark A Fogel
- Departments of Pediatrics (Cardiology) and Radiology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, (M.A.F.).,Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA, (M.A.F.)
| | - Shaftkat Anwar
- Department of Pediatrics (Cardiology) and Radiology, The University of California-San Francisco School of Medicine, San Francisco, USA, (S.A.)
| | - Craig Broberg
- Division of Cardiovascular Medicine, Oregon Health and Sciences University, Portland, USA, (C.B.)
| | - Lorna Browne
- Department of Radiology, University of Colorado, Denver, USA, (L.B.)
| | - Taylor Chung
- Department of Radiology and Biomedical Imaging, The University of California-San Francisco School of Medicine, San Francisco, USA, (T.C.)
| | - Tiffanie Johnson
- Department of Pediatrics (Cardiology), Indiana University School of Medicine, Indianapolis, USA, (T.J.)
| | - Vivek Muthurangu
- Department of Pediatrics (Cardiology), University College London, London, UK, (V.M.)
| | - Michael Taylor
- Department of Pediatrics (Cardiology), University of Cincinnati School of Medicine, Cincinnati, USA, (M.T.)
| | | | - Carolyn Wilhelm
- Department of Pediatrics (Cardiology), University Hospitals-Cleveland, Cleaveland, USA (C.W.)
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11
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Branch pulmonary artery stenosis after arterial switch operation: The effect of preoperative anatomic factors on reintervention. J Thorac Cardiovasc Surg 2022; 164:317-327.e8. [PMID: 35437174 DOI: 10.1016/j.jtcvs.2021.10.084] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 10/20/2021] [Accepted: 10/25/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND We hypothesized that preoperative patient characteristics and branch pulmonary artery (PA) size might influence the rate of postoperative branch PA reintervention in patients with transposition of the great arteries who undergo the arterial switch operation (ASO). METHODS The retrospective single-center study included 262 consecutive (2008-2017) newborns who underwent the ASO. Demographic characteristics, echocardiography, and clinical outcomes were reviewed. Competing risk analysis modeled incidence of branch PA reintervention and cause-specific hazard regression for predictors analyses. RESULTS Median age and weight were 7 (range, 5-11) days and 3.4 (range, 3.1-3.8) kg, respectively. Various types of early branch PA reinterventions (concomitant revision or reintervention during the intensive care unit stay) were required in 28 (10.7%) patients. These patients had prolonged ventilation (P < .001), intensive care unit duration (P < .001), worse right ventricular function (P = .043), and high in-hospital mortality (P = .010). Branch PA dimensions significantly decreased immediately after ASO compared with baseline measurements. The median follow-up duration was 20.8 (range, 0.9-44.7) months. Branch PA reintervention was common among survivors without early reinterventions (9.4%), and even more frequent among those with early reinterventions (25%). Subsequent reintervention (all catheter-based) was necessary for more than one-third of patients after initial branch PA reintervention. The multivariable analysis showed preoperative dimension of the left PA (hazard ratio, 0.527 [95% CI, 0.337-0.823]; P = .005), and right PA (hazard ratio, 0.503 [95% CI, 0.318-0.796]; P = .003) were independently associated with late branch PA reinterventions. CONCLUSIONS Branch PA reintervention was common and often required surgical or catheter-based reinterventions after ASO. PA branch diameters became significantly smaller after ASO. Smaller preoperative branch PA predicted late branch PA reintervention, indicating a smaller margin of geometrical tolerance to this effect.
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12
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Arcieri L, Brambilla A, Ravaglioli A, Viacava C, Federici D, Poli V, Pak V, Murzi B. Neo-aortic posterior sinus of Valsalva reduction and closed coronary artery transfer as a method to approach aortopulmonary mismatch in transposition of great arteries. J Card Surg 2021; 36:3665-3670. [PMID: 34312916 DOI: 10.1111/jocs.15820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/07/2021] [Accepted: 06/14/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE In transposition of great arteries (TGA), aortopulmonary mismatch (APM) can determine postoperative neo-aortic insufficiency after arterial switch operation (ASO). The distortion of sinu-tubular junction may be the geometric mechanism responsible. We developed a strategy able to reduce the mismatch at the timing of ASO, and in this study, we aimed to describe our indications and results. METHODS Preoperative root circumferences at the level of the mid-portion of sinus of Valsalva and ascending aorta circumference were used to define APM. Indication to surgery was a neo-aortic root (NAR) to ascending aorta ratio ≥ 1.4. Along with standard ASO, posterior neo-aortic sinus inverted conal resection and punch technique for coronary reimplantation was used in all patients to re-establish the more geometric ratio possible between the two components. Hypoplastic aortic arch (HAA) and aortic coarctation (CA) were managed by aortic arch enlargement with an autologous pericardial patch. RESULTS Twenty patients (20 male), 19 with diagnoses TGA (17 with ventricular septal defect, 85%) and 1 with Taussig-Bing anomaly underwent ASO. HAA was present in three (15%) and CA in two (10%). The mean preoperative neo-aortic to ascending aorta ratio was 1.8 versus 1.1 postoperatively (p < .01). No moderate or severe neo-aortic insufficiency was observed before discharge and at a mean follow-up of 4.3 years (interquartile range = 0.5-12 years). CONCLUSION Neo-aortic reduction plasty with coronary reimplantation by punch technique is an effective strategy to approach preoperative APM in TGA. This technique confers a more harmonious geometry to NAR that can improve neo-aortic valve function.
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Affiliation(s)
- Luigi Arcieri
- Pediatric Heart Surgery Unit, Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Alice Brambilla
- Pediatric and Neonatology Unit, Santa Maria Annunziata Hospital, Florence, Italy
| | - Antonio Ravaglioli
- Pediatric Heart Surgery Unit, Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Cecilia Viacava
- Pediatric Cardiology Unit, Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Duccio Federici
- Pediatric Heart Surgery Unit, Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Vincenzo Poli
- Pediatric Heart Surgery Unit, Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Vitali Pak
- Pediatric Heart Surgery Unit, Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Bruno Murzi
- Pediatric Heart Surgery Unit, Heart Hospital, G. Monasterio Foundation, Massa, Italy
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13
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Hongu H, Yamagishi M, Maeda Y, Itatani K, Shimada M, Nakatsuji H, Hohri Y, Nabeshima J, Yaku H. Alternative pulmonary artery reconstruction technique in the arterial switch operation. Eur J Cardiothorac Surg 2021; 60:98-104. [PMID: 33595054 DOI: 10.1093/ejcts/ezab049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/07/2020] [Accepted: 12/18/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Late complications of arterial switch operations (ASO) for transposition of the great arteries, such as neo-pulmonary artery (PA) stenosis and/or neoaortic regurgitation, have been reported. We developed an alternative reconstruction method called the longitudinal extension (LE) method to prevent PA bifurcation stenosis (PABS). METHODS We identified 48 patients diagnosed with transposition of the great arteries and performed ASO using the Lecompte manoeuvre for neo-PA reconstruction. In 9 consecutive patients (from 2014), the LE method was performed (LE). Before 2014, conventional techniques were performed in 39 patients (C). The median body weight and age in the LE and C groups were 3.0 and 3.1 kg and 12 and 26 days, respectively. In the LE group, 1 patient underwent bilateral PA banding before ASO. In C, PA banding and arch repair were performed in 1 patient each. Patients who received concomitant procedures were included. RESULTS The median follow-up in LE and C groups was 1.9 and 10.1 years, respectively. Early mortality/late death was not found in group LE and in 1 patient in group C. Only 1 case required ascending aorta sliding plasty in LE, and 8 patients needed PA augmentation for PABS in C. The median velocity of right/left PA was measured as 1.6/1.9 m/s in LE and 2.1/2.3 m/s in C, so it showed a lower value in LE. CONCLUSIONS Excellent mid-term results were obtained with the LE method. It was considered a useful procedure in preventing PABS, which is a primary late complication of ASO. Further follow-up and investigations are needed.
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Affiliation(s)
- Hisayuki Hongu
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaaki Yamagishi
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshinobu Maeda
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiichi Itatani
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masatoshi Shimada
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroki Nakatsuji
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yu Hohri
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Jyunya Nabeshima
- Department of Pediatric Cardiovascular Surgery, Children's Medical Center, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Yaku
- Division of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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14
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Patel PM, Herrmann JL, Bain E, Ladowski JM, Colgate C, Rodefeld MD, Turrentine MW, Brown JW. Risk Factors for Reoperation After Arterial Switch Operation. World J Pediatr Congenit Heart Surg 2021; 12:463-470. [PMID: 34278862 DOI: 10.1177/21501351211009768] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The timing and nature of and risk factors for reoperation after the arterial switch operation in the setting of d-transposition of the great arteries requires further elucidation. METHODS A total of 403 patients who underwent arterial switch operation from 1986 to 2017 were reviewed. Institutional preference was for pulmonary artery reconstruction using a pantaloon patch of fresh autologous pericardium. The targets for coronary artery reimplantation were identified by intermittent root distension. Multivariable analysis was used to identify risk factors for reoperation. RESULTS Median follow-up was 8.6 years (interquartile range [IQR]: 2-16.9). Pulmonary arterioplasty was the most common reoperation (n = 11, 2.7%) at 3.3 years (IQR: 1.4-11.4) postoperatively. Subvalvar right ventricular outflow tract reconstruction (RVOTR) was required in nine (2.2%) patients at 2.5 years (IQR: 1.1-5.3) postoperatively. Aortic valve repair or replacement (AVR/r) was required in seven (1.7%) patients at 13.6 years (IQR: 10.0-15.8) postoperatively. Aortic root replacement (ARR) and Coronary Artery Bypass Graft/coronary patch arterioplasty were required in five (1.2%) patients each at 13.6 years (IQR: 11.0-15.3) and 11.3 years (IQR: 2.3-13.6) postoperatively, respectively. Taussig-Bing anomaly was a risk factor for any reoperation (P = .034). Risk factors for specific reoperations included ventricular septal defect for AVR/r (P = .038), Taussig-Bing anomaly for RVOTR (P = .004), and pulmonary artery banding for ARR (P = .028). CONCLUSIONS Pantaloon patch pulmonary artery reconstruction and intermittent neo-aortic root distension during coronary reimplantation have minimized respective outflow tract reoperations. Certain anatomic subsets carry different risks for late reoperation, and pulmonary artery and/or RVOT reinterventions tend to occur sooner than aortic reinterventions. Special attention to these higher risk subpopulations will be critical to optimizing lifelong outcomes.
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Affiliation(s)
- Parth M Patel
- Division of Thoracic and Cardiovascular Surgery, 12250Indiana University School of Medicine, Indianapolis, IN, USA.,* These two authors contributed equally to this work
| | - Jeremy L Herrmann
- Division of Thoracic and Cardiovascular Surgery, 12250Indiana University School of Medicine, Indianapolis, IN, USA.,22536Riley Children's Health at Indiana University Health, Indianapolis, IN, USA.,* These two authors contributed equally to this work
| | - Eric Bain
- Division of Thoracic and Cardiovascular Surgery, 12250Indiana University School of Medicine, Indianapolis, IN, USA
| | - Joseph M Ladowski
- Division of Thoracic and Cardiovascular Surgery, 12250Indiana University School of Medicine, Indianapolis, IN, USA
| | - Cameron Colgate
- Division of Thoracic and Cardiovascular Surgery, 12250Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mark D Rodefeld
- Division of Thoracic and Cardiovascular Surgery, 12250Indiana University School of Medicine, Indianapolis, IN, USA.,22536Riley Children's Health at Indiana University Health, Indianapolis, IN, USA
| | - Mark W Turrentine
- Division of Thoracic and Cardiovascular Surgery, 12250Indiana University School of Medicine, Indianapolis, IN, USA.,22536Riley Children's Health at Indiana University Health, Indianapolis, IN, USA
| | - John W Brown
- Division of Thoracic and Cardiovascular Surgery, 12250Indiana University School of Medicine, Indianapolis, IN, USA.,22536Riley Children's Health at Indiana University Health, Indianapolis, IN, USA
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15
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van der Palen RLF, Blom NA, Kuipers IM, Rammeloo LAJ, Jongbloed MRM, Konings TC, Bouma BJ, Koolbergen DR, Hazekamp MG. Long-term outcome after the arterial switch operation: 43 years of experience. Eur J Cardiothorac Surg 2021; 59:968-977. [PMID: 33942860 PMCID: PMC8106945 DOI: 10.1093/ejcts/ezab006] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/16/2020] [Accepted: 12/09/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The objective of this study was to assess our 43-year experience with arterial switch operation (ASO) for transposition of the great arteries (TGA) by analysing cardiac outcome measures (hospital and late mortality, reoperations and catheter interventions, significant coronary artery obstruction) and to identify risk factors for reoperation and catheter interventions. METHODS A total of 490 patients who underwent ASO for TGA from 1977 to 2020 were included in this retrospective, single-centre study. Data on reoperation and catheter intervention of hospital survivors were estimated by the Kaplan-Meier method and compared using a long-rank test. Risk factors for reoperation and/or catheter intervention were assessed by multivariate Cox regression analysis. RESULTS Hospital mortality occurred in 43 patients (8.8%), late death in 12 patients (2.9%) and 43 patients were lost to follow-up. Median follow-up time of 413 hospital survivors was 15.6 (interquartile range 7.0-22.4) years. Reoperations were performed in 83 patients (117 reoperations). Neoaortic valve regurgitation with root dilatation was the second most common indication for reoperation (15/83 patients, 18.1%) after right ventricular outflow tract obstruction (50/83 patients, 60.2%). Risk factors for any reoperation on multivariable analysis were: TGA morphological subtype [TGA with ventricular septal defect: hazard ratio (HR) = 1.99, 95% confidence interval (CI) 1.18-3.36; P = 0.010 and Taussig-Bing: HR = 2.17, 95% CI 1.02-4.64; P = 0.045], aortic arch repair associated with ASO (HR = 3.03, 95% CI 1.62-5.69; P = 0.001) and a non-usual coronary artery anatomy (HR = 2.41, 95% CI 1.45-4.00; P = 0.001). One hundred and one catheter interventions were performed in 54 patients, usually for relief of supravalvular pulmonary stenosis (44/54 patients, 81.5%) or arch obstruction (10/54 patients, 18.5%). Main risk factor for catheter intervention on multivariable analysis was aortic arch repair associated with ASO (HR = 2.95, 95% CI 1.37-6.36; P = 0.006). Significant coronary artery stenosis was relatively uncommon (9/413 patients, 2.2%) but may be underrepresented. CONCLUSIONS Patients after ASO typically have good long-term clinical outcomes but reoperations and interventions remain necessary in some patients. Neoaortic valve regurgitation with root dilatation is the second most common indication for reoperation after right ventricular outflow tract obstruction and an increasing need for neoaortic valve and root redo surgery in future is to be expected.
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Affiliation(s)
- Roel L F van der Palen
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Nico A Blom
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
- Division of Pediatric Cardiology, Department of Pediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Irene M Kuipers
- Division of Pediatric Cardiology, Department of Pediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Lukas A J Rammeloo
- Division of Pediatric Cardiology, Department of Pediatrics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Thelma C Konings
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Berto J Bouma
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - David R Koolbergen
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiothoracic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiothoracic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Cleuziou J, Huber AK, Strbad M, Ono M, Hager A, Hörer J, Lange R. Factors Affecting Health-Related Quality of Life After the Arterial Switch Operation. World J Pediatr Congenit Heart Surg 2021; 12:344-351. [PMID: 33942696 DOI: 10.1177/2150135121990651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Long-term morbidity and mortality outcomes of the arterial switch operation (ASO) in patients with transposition of the great arteries and Taussig-Bing anomaly are excellent. With an increasing number of patients reaching adolescence and adulthood, more attention is directed toward quality of life. Our study aimed to determine the health-related quality of life (hrQoL) outcomes in patients after the ASO and identify factors influencing their hrQoL. METHODS In this cross-sectional study, hrQoL of patients after ASO was assessed with the German version of the Short Form-36 (SF-36) and the potential association of specified clinical factors was analyzed. Patients of at least 14 years of age who underwent ASO in our institution from 1983 were considered eligible. RESULTS Of the 355 questionnaires sent to eligible patients, 261 (73%) were available for analysis. Compared to the reference population, patients who had undergone ASO had a significantly higher score in all subscales of the SF-36 except for vitality (P < .01). Patients with an implanted pacemaker (P = .002), patients who required at least one reoperation (P < .001), and patients currently taking cardiac medication (P < .004) or oral anticoagulation (P = .036) had lower physical component scores compared to patients without these factors. CONCLUSIONS Patients' self-assessed and self-reported hrQoL after ASO (using German version of the Short Form 36) is very good. In this population, hrQoL is influenced by reoperation, the need for a pacemaker, and current cardiac medication or anticoagulant use. The development of strategies designed to mitigate or minimize the requirements for, and/or impact of these factors may lead to better hrQoL in this patient population.
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Affiliation(s)
- Julie Cleuziou
- Department of Congenital and Pediatric Heart Surgery, 14924German Heart Center Munich, Technical University of Munich, School of Medicine, Munich, Germany.,Institute for Translational Cardiac Surgery (INSURE), 14924German Heart Center Munich, Technical University of Munich, School of Medicine, Munich, Germany
| | - Anna-Katharina Huber
- Department of Congenital and Pediatric Heart Surgery, 14924German Heart Center Munich, Technical University of Munich, School of Medicine, Munich, Germany
| | - Martina Strbad
- Department of Congenital and Pediatric Heart Surgery, 14924German Heart Center Munich, Technical University of Munich, School of Medicine, Munich, Germany
| | - Masamichi Ono
- Department of Congenital and Pediatric Heart Surgery, 14924German Heart Center Munich, Technical University of Munich, School of Medicine, Munich, Germany
| | - Alfred Hager
- Department of Pediatric Cardiology and Congenital Heart Defects, 14924German Heart Center Munich, Technical University of Munich, School of Medicine, Munich, Germany
| | - Jürgen Hörer
- Department of Congenital and Pediatric Heart Surgery, 14924German Heart Center Munich, Technical University of Munich, School of Medicine, Munich, Germany.,Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Rüdiger Lange
- Institute for Translational Cardiac Surgery (INSURE), 14924German Heart Center Munich, Technical University of Munich, School of Medicine, Munich, Germany.,Department of Cardiovascular Surgery, 14924German Heart Center Munich, Technical University of Munich, School of Medicine, Munich, Germany.,German Center for Cardiovascular Research (DZHK)-Partner site Munich Heart Alliance, Munich, Germany
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18
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Fricke TA, Buratto E, Weintraub RG, Bullock A, Wheaton G, Grigg L, Disney P, d'Udekem Y, Brizard CP, Konstantinov IE. Long-term outcomes of the arterial switch operation. J Thorac Cardiovasc Surg 2021; 163:212-219. [PMID: 33715839 DOI: 10.1016/j.jtcvs.2021.01.134] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/06/2021] [Accepted: 01/29/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The arterial switch operation (ASO) has excellent early outcomes in the modern era. We sought to determine the long-term outcomes in patients who underwent an ASO at a single institution. METHODS Patients who underwent an ASO between 1983 and 2015 were identified from the hospital database and retrospectively reviewed using hospital records. RESULTS From 1983 to 2015, 844 patients with a biventricular circulation underwent an ASO. There were 28 (3.3%, 28/844) early deaths. Follow-up was available for 94% (729/774) of local patients after hospital discharge. Median follow-up was 15 years (interquartile range, 8-20 years). There were 187 (26%, 187/729) patients with more than 20 years of follow-up and 95 (13%, 95/729) patients with more than 25 years of follow-up. Overall survival was 95% (95% confidence interval [CI], 94%-97%) at 10 and 25 years after the ASO. At 25 years after ASO, freedom from overall reintervention was 77% (95% CI, 73%-81%), freedom from reoperation on the neoaortic root or neoaortic valve was 92% (95% CI, 88%-95%), and freedom from coronary reoperation was 99% (95% CI, 98%-99.7%). Left ventricular (LV) systolic function was normal in 595 of 609 (98%) of patients who had LV function quantified at latest follow-up. Of the 95 patients with more than 25 years of follow-up after ASO, 6 (6.3%) had at least moderate neoaortic valve regurgitation (AR) and 8 (8.4%) had undergone replacement of the neoaortic valve. CONCLUSIONS Overall, survivors of ASO have excellent late survival and normal LV systolic function into adult life. However, AR and reoperation on the neoaortic valve remains an issue for older patients.
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Affiliation(s)
- Tyson A Fricke
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Edward Buratto
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Robert G Weintraub
- University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Department of Cardiology, The Royal Children's Hospital, Melbourne, Australia
| | - Andrew Bullock
- Department of Cardiology, Perth Children's Hospital, Perth, Australia
| | - Gavin Wheaton
- Department of Cardiology, Women and Children's Hospital, Adelaide, Australia
| | - Leeanne Grigg
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Patrick Disney
- Department of Cardiology, The Royal Adelaide Hospital, Adelaide, Australia
| | - Yves d'Udekem
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Christian P Brizard
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, The Royal Children's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Melbourne Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia.
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Pewowaruk R, Hermsen J, Johnson C, Erdmann A, Pettit K, Aesif S, Ralphe JC, Francois CJ, Roldán-Alzate A, Lamers L. Pulmonary artery and lung parenchymal growth following early versus delayed stent interventions in a swine pulmonary artery stenosis model. Catheter Cardiovasc Interv 2020; 96:1454-1464. [PMID: 33063918 PMCID: PMC10831906 DOI: 10.1002/ccd.29326] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Compare lung parenchymal and pulmonary artery (PA) growth and hemodynamics following early and delayed PA stent interventions for treatment of unilateral branch PA stenosis (PAS) in swine. BACKGROUND How the pulmonary circulation remodels in response to different durations of hypoperfusion and how much growth and function can be recovered with catheter directed interventions at differing time periods of lung development is not understood. METHODS A total of 18 swine were assigned to four groups: Sham (n = 4), untreated left PAS (LPAS) (n = 4), early intervention (EI) (n = 5), and delayed intervention (DI) (n = 5). EI had left pulmonary artery (LPA) stenting at 5 weeks (6 kg) with redilation at 10 weeks. DI had stenting at 10 weeks. All underwent right heart catheterization, computed tomography, magnetic resonance imaging, and histology at 20 weeks (55 kg). RESULTS EI decreased the extent of histologic changes in the left lung as DI had marked alveolar septal and bronchovascular abnormalities (p = .05 and p < .05 vs. sham) that were less prevalent in EI. EI also increased left lung volumes and alveolar counts compared to DI. EI and DI equally restored LPA pulsatility, R heart pressures, and distal LPA growth. EI and DI improved, but did not normalize LPA stenosis diameter (LPA/DAo ratio: Sham 1.27 ± 0.11 mm/mm, DI 0.88 ± 0.10 mm/mm, EI 1.01 ± 0.09 mm/mm) and pulmonary blood flow distributions (LPA-flow%: Sham 52 ± 5%, LPAS 7 ± 2%, DI 44 ± 3%, EI 40 ± 2%). CONCLUSION In this surgically created PAS model, EI was associated with improved lung parenchymal development compared to DI. Longer durations of L lung hypoperfusion did not detrimentally affect PA growth and R heart hemodynamics. Functional and anatomical discrepancies persist despite successful stent interventions that warrant additional investigation.
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Affiliation(s)
- Ryan Pewowaruk
- Biomedical Engineering, University of Wisconsin – Madison
| | - Joshua Hermsen
- School of Medicine and Public Health, University of Wisconsin – Madison
- Cardiovascular Surgery, University of Wisconsin – Madison
| | | | - Alexandra Erdmann
- School of Medicine and Public Health, University of Wisconsin – Madison
| | - Kevin Pettit
- School of Medicine and Public Health, University of Wisconsin – Madison
| | - Scott Aesif
- School of Medicine and Public Health, University of Wisconsin – Madison
- Pathology, University of Wisconsin – Madison
| | - J. Carter Ralphe
- School of Medicine and Public Health, University of Wisconsin – Madison
- Pediatrics, Division of Cardiology, University of Wisconsin – Madison
| | - Christopher J. Francois
- School of Medicine and Public Health, University of Wisconsin – Madison
- Radiology, University of Wisconsin – Madison
| | - Alejandro Roldán-Alzate
- Biomedical Engineering, University of Wisconsin – Madison
- Mechanical Engineering, University of Wisconsin – Madison
- Radiology, University of Wisconsin – Madison
| | - Luke Lamers
- School of Medicine and Public Health, University of Wisconsin – Madison
- Pediatrics, Division of Cardiology, University of Wisconsin – Madison
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Dedemoğlu M, Korun O, Coşkun G, Özdemir F, Yurdakök O, Çiçek M, Biçer M, Yurtseven N, Şaşmazel A, Aydemir NA. The poor long-term outcomes of owl's eye pulmonary reconstruction technique after arterial switch operation. Interact Cardiovasc Thorac Surg 2020; 31:113-120. [PMID: 32500154 DOI: 10.1093/icvts/ivaa067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/18/2020] [Accepted: 03/21/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study aims to compare the early- and long-term outcomes of patients who undergo owl's eye pulmonary artery (PA) reconstruction to those of patients who undergo conventional PA reconstruction. METHODS From January 2016 to January 2017, 64 consecutive patients underwent an arterial switch operation. The patients were divided into 2 groups in terms of neo-PA reconstruction method: 30 patients who underwent neo-PA reconstruction by owl's eye technique were defined as group 1 and 34 patients who underwent neo-PA reconstruction by the conventional approach were defined as group 2. In the final model, after propensity matching, 23 patients from each group with similar propensity scores were included in the study. RESULTS There was no significant difference between the groups regarding patient characteristics and operative findings. In the early period, the duration of intensive care unit and hospital stays and the rate of mild neo-pulmonary stenosis (neo-PS) were significantly higher in the owl's eye group (P = 0.04, 0.04 and 0.03). In the late period, the rate of severe neo-PS and reintervention was significantly higher in the owl's eye group (P = 0.02 and 0.04). Furthermore, the rates of 3-year freedom from pulmonary reintervention and freedom from moderate-severe neo-PS were significantly lower in group 1 (P = 0.04). In addition, the owl's eye reconstruction was the only factor independently related to moderate-severe neo-PS in the long term (hazard ratios = 11.2, P = 0.02). CONCLUSIONS We have abandoned the owl's eye method for neo-PA reconstruction of the neo-PA because of serious complications. According to our series and the literature, reconstruction of the neo-PA with an oversized, pantaloon-shaped fresh autologous pericardial patch is still superior to the other techniques.
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Affiliation(s)
- Mehmet Dedemoğlu
- Department of Pediatric Cardiovascular Surgery, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Oktay Korun
- Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Gültekin Coşkun
- Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Fatih Özdemir
- Department of Pediatric Cardiovascular Surgery, Gazi Yaşargil Education and Research Hospital, Diyarbakır, Turkey
| | - Okan Yurdakök
- Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Murat Çiçek
- Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Biçer
- Department of Pediatric Cardiovascular Surgery, Health Sciences University Erzurum Region Education and Research Hospital, Erzurum, Turkey
| | - Nurgül Yurtseven
- Department of Anesthesia and Reanimation, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Şaşmazel
- Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Numan Ali Aydemir
- Department of Pediatric Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Santens B, Van De Bruaene A, De Meester P, Gewillig M, Troost E, Claus P, Bogaert J, Budts W. Outcome of arterial switch operation for transposition of the great arteries. A 35-year follow-up study. Int J Cardiol 2020; 316:94-100. [PMID: 32348813 DOI: 10.1016/j.ijcard.2020.04.072] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/04/2020] [Accepted: 04/24/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Arterial switch operation (ASO) is today the first-choice surgical treatment for patients with transposition of the great arteries. Long-term outcome data still remain scarce. Moreover, the course of these patients is not uneventful. Therefore, we wanted to evaluate long-term outcome and determine on which variables to focus during follow-up. METHODS Clinical records of 318 patients who underwent ASO between October 1981 and July 2018 were reviewed. Perioperative, post-operative, and interventional data were collected to determine mortality and the need for re-intervention. Descriptive statistics and Kaplan-Meier survival analysis were performed. RESULTS Mean follow-up time was 11.1 SD 8.5 years (range 0-35) with a mean age of 12.5 SD 9.0 years (range 0-37) at latest follow-up. In-hospital mortality was 7.5% and overall survival 90.9% for a maximum follow-up time of 35 years. Causes of early mortality were cardiogenic shock, severe pulmonary hypertension, septic shock and multiple organ failure. Causes of late mortality were cardiogenic shock, severe pulmonary hypertension, pacemaker lead fracture and fire death. Re-intervention free survival at 5-year was 91.6%, at 10-year 90.7%, at 20-year 79.2%. For all survivors, the most frequent sequelae after ASO were pulmonary artery stenosis (80.9%), of which 13.5% needed an intervention. The threshold for intervening on lesions at the level of the pulmonary artery bifurcation was higher and the percutaneous re-intervention rate was higher for non-bifurcation lesions. CONCLUSIONS Despite a relatively high peri-operative mortality, TGA patients have an excellent overall long-term survival. However, a large proportion of patients requires re-interventions, mainly for pulmonary artery stenosis.
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Affiliation(s)
- Béatrice Santens
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Alexander Van De Bruaene
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Pieter De Meester
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Marc Gewillig
- Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium; Department of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Els Troost
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Piet Claus
- Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Jan Bogaert
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, Catholic University Leuven, Leuven, Belgium
| | - Werner Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium.
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Chen SJ, Huang SC. Commentary: Transposition with aortic arch obstruction: The lesions switched? J Thorac Cardiovasc Surg 2019; 159:600-601. [PMID: 31669010 DOI: 10.1016/j.jtcvs.2019.08.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 08/26/2019] [Accepted: 08/28/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Shyh-Jye Chen
- Department of Radiology and Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Shu-Chien Huang
- Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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van der Palen RL, van der Zee C, Vink AS, Knobbe I, Jurgens SJ, van Leeuwen E, Bax CJ, du Marchie Sarvaas GJ, Blom NA, Haak MC, Bilardo CM, Clur SB. Transposition of the great arteries: Fetal pulmonary valve growth and postoperative neo-aortic root dilatation. Prenat Diagn 2019; 39:1054-1063. [PMID: 31351016 PMCID: PMC6900129 DOI: 10.1002/pd.5539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/05/2019] [Accepted: 07/16/2019] [Indexed: 12/04/2022]
Abstract
AbstractObjectivesDocumentation of semilunar valve growth in fetal transposition of the great arteries (TGA) and the relationship between neo‐aortic root (NAoR) dilatation, a cause for postoperative reinterventions after the arterial switch operation (ASO), and pulmonary valve (PV) annulus dimensions prenatally.MethodsThis retrospective multicenter observational study included TGA fetuses suitable for ASO. Semilunar valve annuli pre‐ASO and NAoR diameters (post‐ASO) were measured. Trends in annulus diameters were analyzed using a linear mixed‐effects model and compared with normal values. Prenatal semilunar valve Z‐scores were correlated with NAoR diameters post‐ASO.ResultsWe included 137 TGA fetuses (35.8% with significant ventricular septal defects [VSDs]). One hundred twenty‐one underwent ASO. Fetal TGA‐PV diameters were significantly larger than control aortic valve (AoV) and PV annuli from 23 and 27 weeks, respectively, especially when a VSD was present. Fetal TGA‐AoV annuli were significantly larger than control AoV and PV annuli from 26 and 30 weeks, respectively.Z‐scores of fetal TGA‐PV and NAoR diameter at last follow‐up correlated significantly (P < .001 at 26‐30 wk).ConclusionFetal TGA semilunar valve annuli are larger than control annuli, especially when there is a significant VSD. Factors besides postoperative hemodynamics, including fetal anatomy, PV Z‐score, prenatal flow, connective tissue properties, and genetics, may influence the risk for late reintervention in these fetuses.
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Affiliation(s)
- Roel L.F. van der Palen
- Division of Pediatric Cardiology, Department of PediatricsLeiden University Medical CentreLeidenThe Netherlands
| | - Carlijn van der Zee
- Department of Pediatric CardiologyEmma Children's Hospital, Amsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Arja S. Vink
- Department of Pediatric CardiologyEmma Children's Hospital, Amsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
- Heart Centre, Department of CardiologyAcademic Medical Centre, Amsterdam UMCAmsterdamThe Netherlands
| | - Ingmar Knobbe
- Department of Pediatric CardiologyAmsterdam UMC, Free UniversityAmsterdamThe Netherlands
| | - Sean J. Jurgens
- Department of Pediatric CardiologyEmma Children's Hospital, Amsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Elizabeth van Leeuwen
- Department of Prenatal DiagnosisAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Caroline J. Bax
- Department of Prenatal DiagnosisAmsterdam UMC, Free UniversityAmsterdamThe Netherlands
| | | | - Nico A. Blom
- Division of Pediatric Cardiology, Department of PediatricsLeiden University Medical CentreLeidenThe Netherlands
- Department of Pediatric CardiologyEmma Children's Hospital, Amsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Monique C. Haak
- Department of Prenatal DiagnosisLeiden University Medical CentreLeidenThe Netherlands
| | - Caterina M. Bilardo
- Department of Prenatal DiagnosisUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Sally‐Ann B. Clur
- Department of Pediatric CardiologyEmma Children's Hospital, Amsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
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Nakayama Y, Shinkawa T, Matsumura G, Hoki R, Kobayashi K, Niinami H. Late Neo–Aortic Valve Regurgitation Long After Arterial Switch Operation. Ann Thorac Surg 2019; 108:1210-1216. [DOI: 10.1016/j.athoracsur.2019.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/23/2019] [Accepted: 04/02/2019] [Indexed: 10/26/2022]
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25
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Loke YH, Capuano F, Mandell J, Cross RR, Cronin I, Mass P, Balaras E, Olivieri LJ. Abnormal Pulmonary Artery Bending Correlates With Increased Right Ventricular Afterload Following the Arterial Switch Operation. World J Pediatr Congenit Heart Surg 2019; 10:572-581. [PMID: 31496415 DOI: 10.1177/2150135119861358] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE In transposition of great arteries, increased right ventricular (RV) afterload is observed following arterial switch operation (ASO), which is not always related to pulmonary artery (PA) stenosis. We hypothesize that abnormal PA bending from the Lecompte maneuver may affect RV afterload in the absence of stenosis. Thus, we sought to identify novel measurements of three-dimensional cardiac magnetic resonance (CMR) images of the pulmonary arteries and compare with conventional measurements in their ability to predict RV afterload. METHODS Conventional measurements and novel measurements of the pulmonary arteries were performed using CMR data from 42 ASO patients and 13 age-matched controls. Novel measurements included bending angle, normalized radius of curvature (Rc), and normalized weighted radius of curvature (Rc-w). Right ventricular systolic pressures (as the surrogate for RV afterload) were measured by either recent echocardiogram or cardiac catheterization. RESULTS Conventional measurements of proximal PA size correlated with differential pulmonary blood flow (r = 0.49, P = .001), but not with RV peak systolic pressures (r = -0.26, P = .18). In ASO patients, Rc-w correlated with higher RV systolic pressures (r = -0.57, P = .002). Larger neoaortic areas and rightward bending angles correlated with smaller right pulmonary artery Rc (r = -0.48, P = .001; r = 0.41, P = .01, respectively). Finally, both pulmonary arteries had significantly smaller Rc compared to normal controls. CONCLUSIONS Pulmonary arteries exhibit abnormal bends following ASO that correlate with increased RV afterload, independent of PA stenosis. Future work should focus on clinical and hemodynamic contributions of these shape parameters.
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Affiliation(s)
- Yue-Hin Loke
- Division of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Francesco Capuano
- Department of Industrial Engineering, Universita di Napoli Federico II, Naples, Italy
| | - Jason Mandell
- Division of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Russell R Cross
- Division of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Ileen Cronin
- Division of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Paige Mass
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, Washington, DC, USA
| | - Elias Balaras
- Department of Mechanical and Aerospace Engineering, George Washington University, Washington, DC, USA
| | - Laura J Olivieri
- Division of Cardiology, Children's National Medical Center, Washington, DC, USA.,Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Medical Center, Washington, DC, USA
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26
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Long-Term Growth of the Neoaortic Root After Arterial Switch Operation. Ann Thorac Surg 2019; 107:1203-1211. [DOI: 10.1016/j.athoracsur.2018.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 07/26/2018] [Accepted: 09/12/2018] [Indexed: 11/17/2022]
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Capuano F, Loke YH, Cronin I, Olivieri LJ, Balaras E. Computational Study of Pulmonary Flow Patterns After Repair of Transposition of Great Arteries. J Biomech Eng 2019; 141:2727821. [DOI: 10.1115/1.4043034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Indexed: 11/08/2022]
Abstract
Patients that undergo the arterial switch operation (ASO) to repair transposition of great arteries (TGA) can develop abnormal pulmonary trunk morphology with significant long-term complications. In this study, cardiovascular magnetic resonance was combined with computational fluid dynamics to investigate the impact of the postoperative layout on the pulmonary flow patterns. Three ASO patients were analyzed and compared to a volunteer control. Results showed the presence of anomalous shear layer instabilities, vortical and helical structures, and turbulent-like states in all patients, particularly as a consequence of the unnatural curvature of the pulmonary bifurcation. Streamlined, mostly laminar flow was instead found in the healthy subject. These findings shed light on the correlation between the post-ASO anatomy and the presence of altered flow features, and may be useful to improve surgical planning as well as the long-term care of TGA patients.
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Affiliation(s)
- Francesco Capuano
- Department of Industrial Engineering, Università di Napoli Federico II, Napoli 80125, Italy e-mail:
| | - Yue-Hin Loke
- Division of Cardiology, Children's National Health System, Washington, DC 20010 e-mail:
| | - Ileen Cronin
- Division of Cardiology, Children's National Health System, Washington, DC 20010 e-mail:
| | - Laura J. Olivieri
- Division of Cardiology, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC 20010 e-mail:
| | - Elias Balaras
- Department of Mechanical and Aerospace Engineering, George Washington University, Washington, DC 20052 e-mail:
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28
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Arterial Switch Operation: Operative Approach and Outcomes. Ann Thorac Surg 2019; 107:302-310. [DOI: 10.1016/j.athoracsur.2018.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/26/2018] [Accepted: 06/04/2018] [Indexed: 11/20/2022]
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Martins CN, Gontijo Filho B, Lopes RM, Silva FDCLE. Mid- and Longterm Neo-Aortic Valve Regurgitation after Jatene Surgery: Prevalence and Risk Factors. Arq Bras Cardiol 2018; 111:21-28. [PMID: 29972413 PMCID: PMC6078373 DOI: 10.5935/abc.20180111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 04/25/2018] [Indexed: 11/20/2022] Open
Abstract
Background Jatene surgery became the surgical procedure of choice to repair
transposition of the great arteries (TGA) in neonates and infants. Late
complications, mainly related to the pulmonary outflow tract and coronary
arteries, are well known. The behavior of the neo-aortic valve is a cause of
concern because of its potential for requiring late reoperation. Objectives To assess the prevalence and risk factors of neo-aortic valve regurgitation
in 127 patients in the late postoperative period of the Jatene surgery. Methods Of the 328 survivors of the Jatene surgery at the Biocor Institute from
October 1997 to June 2015, all patients undergoing postoperative follow-up
were contacted via telephone, 127 being eligible for the study. The patients
were divided into two groups, simple TGA and complex TGA groups, with
follow-up means of 6.4 ± 4.7 years and 9.26 ± 4.22 years,
respectively. Echocardiography was performed with adjusted measurements
(Z-score) of the neo-aortic annulus, sinus of Valsalva, sinotubular region
and ascending aorta, as well as quantification of the neo-aortic valve
regurgitation grade. Results The incidence of mild neo-aortic valve regurgitation was 29% in a follow-up
of 7.4 ± 4.7 years. Moderate regurgitation was identified in 24
patients with age mean (± standard-deviation) of 9.81 ± 4.21
years, 19 of whom (79%) in the complex TGA group. Those patients had a
higher aortic annulus Z-score. The reoperation rate due to neo-aortic
regurgitation associated with aortic dilation was 1.5%, all patients in the
complex TGA group. Conclusion This study shows that, despite the low incidence of reoperation after Jatene
surgery due to neo-aorta dilation and neo-aortic valve regurgitation, that
is a time-dependent phenomenon, which requires strict vigilance of the
patients. In this study, one of the major risk factors for neo-aortic valve
regurgitation was the preoperative pulmonary artery diameter (p <
0.001).
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Affiliation(s)
| | | | - Roberto Max Lopes
- BIOCOR Hospital de Doenças Cardiovasculares, Belo Horizonte, MG - Brazil
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30
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Salna M, Chai PJ, Kalfa D, Nakamura Y, Krishnamurthy G, Quaegebeur JM, Najjar M, Shah A, Levasseur S, Anderson BR, Bacha EA. Outcomes of the Arterial Switch Operation in ≤2.5-kg Neonates. Semin Thorac Cardiovasc Surg 2018; 31:488-493. [PMID: 29621622 DOI: 10.1053/j.semtcvs.2018.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2018] [Indexed: 11/11/2022]
Abstract
Although low birth weight is a known risk factor for mortality in congenital heart lesions and may consequently delay surgical repair, outcomes in low-weight neonates undergoing the arterial switch operation (ASO) have not been well described. Our objective was to assess the safety of this procedure in infants weighing ≤2.5 kg at the time of surgery. We retrospectively analyzed outcomes for all neonates undergoing the ASO at our institution from 2005 to 2015. Our primary outcome of interest was major morbidity or operative mortality, assessed as a composite outcome. From 2005 to 2015, 217 neonates underwent the ASO, with 31 (14%) weighing ≤2.5 kg at the date of surgery, and 8 weighing <2.0 kg. Neonates weighing ≤2.5 kg were more likely to be premature than those weighing >2.5 kg, but there was no difference in the age at operation between these groups. Overall, 32 infants experienced a major morbidity or mortality, including 37.5% (n = 3) weighing <2.0 kg, 8.7% (n = 2) weighing 2.0-2.5 kg, and 14.5% (n = 7) weighing >2.5 kg (P = 0.141). One infant weighing <2.0 kg (1.1 kg) and 4 infants weighing >2.5 kg died. In multivariable models, odds of major morbidity or mortality were significantly higher for infants weighing <2 kg compared with infants weighing >2.5 kg (odds ratio 3.93, 95% confidence interval 1.04-14.85, P = 0.044), but there was no difference between infants weighing 2.0-2.5 kg and those weighing >2.5 kg (P = 0.225). The ASO can be performed safely in 2.0- to 2.5-kg neonates and yields results comparable with higher weight infants. Imposed delays for corrective surgery may not be necessary for these low-weight infants with transposition of the great arteries.
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Affiliation(s)
- Michael Salna
- Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, New York, New York
| | - Paul J Chai
- Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, New York, New York
| | - David Kalfa
- Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, New York, New York
| | - Yuki Nakamura
- Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, New York, New York
| | - Ganga Krishnamurthy
- Division of Neonatology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York
| | - Jan M Quaegebeur
- Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, New York, New York
| | - Marc Najjar
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, New York
| | - Amee Shah
- Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York
| | - Stephanie Levasseur
- Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York
| | - Brett R Anderson
- Division of Pediatric Cardiology, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York
| | - Emile A Bacha
- Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, NewYork-Presbyterian/Morgan Stanley Children's Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
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Yoneyama F, Okamura T, Harada Y, Okita Y. Valve-sparing reimplantation for neoaortic root dilatation and regurgitation with an unbalanced cusp after the arterial switch operation. J Card Surg 2018; 33:122-125. [DOI: 10.1111/jocs.13543] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Fumiya Yoneyama
- Department of Cardiovascular Surgery; Kobe University Graduate School of Medicine; Japan
| | - Toru Okamura
- Department of Cardiovascular Surgery; Kobe University Graduate School of Medicine; Japan
| | - Yorikazu Harada
- Department of Cardiovascular Surgery; Kobe University Graduate School of Medicine; Japan
| | - Yutaka Okita
- Kobe University Graduate School of Medicine; Nagano Children's Hospital; Japan
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32
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Xiao Y, Zhang P, Su W, Dong N. Early and mid-term follow-up of patients receiving arterial switch operation: a single-center experience. J Thorac Dis 2018; 10:732-739. [PMID: 29607143 DOI: 10.21037/jtd.2017.12.103] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The arterial switch operation (ASO) has become the preferred method for surgical correction of transposition of the great arteries (TGA) and Taussig-Bing anomaly. This study was aimed to analysis the early and mid-term results of patients receiving ASO for TGA and Taussig-Bing anomaly in our institute. Methods A single-institution retrospective study was conducted to assess cardiovascular outcomes after ASO between January 2007 and December 2013. A total of 119 consecutive patients were included in this study. The median age at operation was 30 days (range, 1 day-8 years), the median weight was 3.8 kg (range, 2.0-23.0 kg). The ventricular septum was intact in 59 (49.6%) patients, 43 (36.1%) had ventricular septal defect, and 17 (14.3%) had a Taussig-Bing anomaly. We followed up patients with echocardiography. Special attention had been paid to the neo-aortic regurgitation and pulmonary stenosis. Results In hospital deaths occurred in 10 (8.4%) patients. The most cause of death was low cardiac output due to deconditioning of the left ventricle and myocardial infarction. Echocardiographic data after ASO were collected in 93 (85.3%) patients at a mean duration of 60.7±20.2 months. Among them, 4 (4.3%) patients had moderate to severe neo-aortic regurgitation, 1 (1.1%) patient had moderate tricuspid regurgitation, 4 (4.3%) patients had moderate pulmonary regurgitation; 1 (1.1%) patients had moderate pulmonary stenosis and no patients had severe stenosis. Only two patients required a surgical reintervention. Conclusions The early mortality rate has decreased and the most cause of death was low cardiac output. The outcomes of the ASO using our reconstruction and reimplantation techniques were excellent and the reoperation rate was very low in the early and mid-term follow-up.
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Affiliation(s)
- Yaqiong Xiao
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Ping Zhang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Wei Su
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Vida VL, Zanotto L, Zanotto L, Stellin G, Padalino M, Sarris G, Protopapas E, Prospero C, Pizarro C, Woodford E, Tlaskal T, Berggren H, Kostolny M, Omeje I, Asfour B, Kadner A, Carrel T, Schoof PH, Nosal M, Fragata J, Kozłowski M, Maruszewski B, Vricella LA, Cameron DE, Sojak V, Hazekamp M, Salminen J, Mattila IP, Cleuziou J, Myers PO, Hraska V. Left-Sided Reoperations After Arterial Switch Operation: A European Multicenter Study. Ann Thorac Surg 2017; 104:899-906. [PMID: 28709661 DOI: 10.1016/j.athoracsur.2017.04.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/21/2017] [Accepted: 04/04/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND We sought to report the frequency, types, and outcomes of left-sided reoperations (LSRs) after an arterial switch operation (ASO) for patients with D-transposition of the great arteries (D-TGA) and double-outlet right ventricle (DORV) TGA-type. 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.
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Affiliation(s)
- Vladimiro L Vida
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy
| | - Lorenza Zanotto
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy
| | - Lucia Zanotto
- Department of Statistical Sciences, University of Padua, Padua, Italy
| | - Giovanni Stellin
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padua, Padua, Italy.
| | - Massimo Padalino
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Georges Sarris
- Athens Heart Surgery Institute and Department of Pediatric and Congenital Cardiac Surgery, Iaso Children's Hospital, Athens, Greece
| | - Eleftherios Protopapas
- Athens Heart Surgery Institute and Department of Pediatric and Congenital Cardiac Surgery, Iaso Children's Hospital, Athens, Greece
| | - Carol Prospero
- Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Christian Pizarro
- Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Edward Woodford
- Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Thomas Tlaskal
- Children's Heart Centre, University Hospital Motol, Prague, Czech Republic
| | - Hakan Berggren
- Department of Molecular and Clinical Medicine, Children's Heart Center, The Queen Silvia's Children's Hospital, Göteborg, Sweden
| | - Martin Kostolny
- Great Ormond Street Hospital, Cardiothoracic Unit, London, UK
| | - Ikenna Omeje
- Great Ormond Street Hospital, Cardiothoracic Unit, London, UK
| | - Boulos Asfour
- Herma Heart Center, Medical College of Wisconsin, Wisconsin, USA
| | - Alexander Kadner
- Department for Cardiovascular Surgery, University of Bern, Bern, Switzerland
| | - Thierry Carrel
- Department for Cardiovascular Surgery, University of Bern, Bern, Switzerland
| | - Paul H Schoof
- University Medical Center Utrecht, Utrecht, Netherlands
| | - Matej Nosal
- Childrens Heart Centre Slovak Republic, Bratislava, Slovakia
| | - Josè Fragata
- Department of Cardiothoracic Surgery, Hospital de Santa Marta and Nova Medical School, Lisbon, Portugal
| | | | | | - Luca A Vricella
- Division of Cardiac Surgery, Johns Hopkins University, Baltimore, USA
| | - Duke E Cameron
- Division of Cardiac Surgery, Johns Hopkins University, Baltimore, USA
| | - Vladimir Sojak
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Mark Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Jukka Salminen
- Division of Pediatric Surgery, Department of Children and Adolescents, Helsinki University Hospital, Helsinki, Finland
| | - Ilkka P Mattila
- Division of Pediatric Surgery, Department of Children and Adolescents, Helsinki University Hospital, Helsinki, Finland
| | - Julie Cleuziou
- Department of Cardiovascular Surgery, German Heart Center Munich Technische Universität München, Munich, Germany
| | - Patrick O Myers
- Divison of cardiovascular Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Viktor Hraska
- Herma Heart Center, Medical College of Wisconsin, Milwaukee, WI, USA
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Clinical guidelines for the management of patients with transposition of the great arteries with intact ventricular septum. Cardiol Young 2017; 27:530-569. [PMID: 28249633 DOI: 10.1017/s1047951117000014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Al Anani S, Fughhi I, Taqatqa A, Elzein C, Ilbawi MN, Polimenakos AC. Transposition of Great Arteries with Complex Coronary Artery Variants: Time-Related Events Following Arterial Switch Operation. Pediatr Cardiol 2017; 38:513-524. [PMID: 27995290 DOI: 10.1007/s00246-016-1543-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
Abstract
Coronary artery anatomy represents a challenging and, often, determining predictor of outcome in an arterial switch operation (ASO). Impact of specific coronary artery variants, such as single, intramural and inverted, on time-related events following ASO, is, yet, to be determined. We sought to compare early and late outcomes within the group of nonstandard coronary artery variants. Patients who underwent ASO from January 1995 to October 2010 were reviewed. Patients with coronary artery variants other than L1Cx1R2 ("standard" by Leiden classification) were included. Patients with single, intramural and inverted coronary artery variants incorporated in group A. All other nonstandard coronary variants incorporated in group B. Demographics, perioperative variables, early and late outcomes were assessed. Of the 123 ASO, 24 patients (19.5%) with nonstandard coronary variant were studied. Thirteen were in group A and 11 in group B. There were two early deaths (1 in group A and 1 in group B) (p > 0.05). There is one death early after hospital discharge (group A). Mean follow-up was 59.4 ± 55.1 months. There was no structural coronary artery failure after hospital discharge following ASO. Freedom from any reintervention at 8 years was (78.3 ± 9.6%) (p 0.55) with no late neo-aortic or mitral valve intervention. ASO with single, intramural or inverted coronary artery course carries no added longitudinal risk for structural or flow impairment within the group of nonstandard coronary artery variants. There is an early hazard period with no late survival attrition. Aortic arch repair as part of staged strategy prior to ASO might influence early and late outcome.
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Affiliation(s)
| | | | - Anas Taqatqa
- Rush University Medical Center, Chicago, IL, USA
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Sarris GE, Balmer C, Bonou P, Comas JV, da Cruz E, Chiara LD, Di Donato RM, Fragata J, Jokinen TE, Kirvassilis G, Lytrivi I, Milojevic M, Sharland G, Siepe M, Stein J, Büchel EV, Vouhé PR. Clinical guidelines for the management of patients with transposition of the great arteries with intact ventricular septum. Eur J Cardiothorac Surg 2017; 51:e1-e32. [DOI: 10.1093/ejcts/ezw360] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sedación para recambio valvular transcatéter de una válvula pulmonar Melody®: informe de caso. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rca.2016.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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38
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Fernández-Castellano G, López-Herrera-Rodríguez D, Domínguez A, Sánchez-Carrillo F. Sedation for transcatheter replacement of Melody® pulmonary valve: Case report. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2016.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Michalak KW, Moll JA, Sobczak-Budlewska K, Moll M, Dryżek P, Moszura T, Szymczyk K, Moll JJ. Reoperations and catheter interventions in patients with transposition of the great arteries after the arterial switch operation. Eur J Cardiothorac Surg 2016; 51:34-42. [DOI: 10.1093/ejcts/ezw290] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 07/22/2016] [Accepted: 07/25/2016] [Indexed: 11/12/2022] Open
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Shikata F, Okamura T, Higaki T, Okura M, Kojima A, Uchita S, Izutani H. Aortic Coarctation 28 Days after an Arterial Switch Operation in a Neonate. Tex Heart Inst J 2016; 43:354-6. [PMID: 27547151 DOI: 10.14503/thij-15-5380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aortic coarctation rarely occurs after an arterial switch operation for D-transposition of the great arteries with intact ventricular septum. We report the case of a neonate patient in whom aortic coarctation developed 28 days after an uncomplicated arterial switch operation. Preoperatively, the aorta was noted to have an irregular shape, but there was no pressure gradient across the lesion. The patient underwent successful reoperation to correct the coarctation. We hope that our report raises awareness of a rare early complication after arterial switch operation with intact ventricular septum, and the need to carefully monitor the aortic isthmus in patients who have aortic irregularities, even in the absence of a pressure gradient.
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Shim MS, Jun TG, Yang JH, Park PW, Kang IS, Huh J, Song JY. Current expectations of the arterial switch operation in a small volume center: a 20-year, single-center experience. J Cardiothorac Surg 2016; 11:34. [PMID: 26911711 PMCID: PMC4766671 DOI: 10.1186/s13019-016-0428-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 02/09/2016] [Indexed: 11/10/2022] Open
Abstract
Background We reviewed our 20-year experience with arterial switch operation (ASO) for transposition of the great arteries (TGA) or double outlet right ventricle with subpulmonary ventricular septal defect (Taussig-Bing anomaly) to assess the early and long-term outcomes. Methods Between January 1995 and December 2014, 139 consecutive patients who underwent ASO for TGA or Taussig-Bing anomaly were included in this retrospective study. The median age at the operation was 9 (0–485) days, and 97 patients (70 %) underwent ASO less than 2 weeks. The median weight was 3.3 (2.1-10.3) kg. The patients were divided into three groups; simple TGA (n = 78) included patients with TGA with intact ventricular septum, complex TGA (n = 46) included those who had TGA with ventricular septal defect or other anomalies, and Taussig-Bing anomaly (n = 15). Median follow-up duration was 72.5 (0.4-230) months. Results There were 3(2.2 %) in-hospital deaths. One patient (0.7 %) underwent early reoperation due to coronary insufficiency. Late deaths occurred in 3 (2.2 %) of 136 survivors. The Kaplan-Meier’s survival rate was 97.6 ± 1.4 % at 15 years. Twenty-three patients (16.9 %) required 26 reintervention. The freedom from reintervention rates were 82.5 ± 3.7 % at 5 years and 75.8 ± 4.7 % at 10 years, respectively. Median interval between ASO and first reintervention was 22.8 (6.4-89.2) months. The multivariate analysis showed that diagnosis of Taussig-Bing anomaly (hazard ratio, 7.09; P < 0.001) and side by side great artery relationship (hazard ratio, 7.98; P = 0.001) were independent risk factors for reoperation. Five patients (3.9 %) had developed at least moderate neo-aortic regurgitation during the follow-up and one patient underwent reoperation mainly for neo-aortic regurgitation. By multivariate analysis, Taussig-Bing anomaly was the risk factor for at least moderate neo-aortic regurgitation (P = 0.035). Conclusions ASO can be performed with a low risk of early mortality and satisfactory long-term outcomes even in a small volume center. Close long-term surveillance is mandatory to detect structural or hemodynamic changes.
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Affiliation(s)
- Man-shik Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Kangnam-gu, Seoul, 135-710, Korea.
| | - Tae-Gook Jun
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Kangnam-gu, Seoul, 135-710, Korea.
| | - Ji-Hyuk Yang
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Kangnam-gu, Seoul, 135-710, Korea.
| | - Pyo Won Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Kangnam-gu, Seoul, 135-710, Korea.
| | - I Seok Kang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - June Huh
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Jin Young Song
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Latham GJ, Joffe DC, Eisses MJ, Richards MJ, Geiduschek JM. Anesthetic Considerations and Management of Transposition of the Great Arteries. Semin Cardiothorac Vasc Anesth 2015; 19:233-42. [DOI: 10.1177/1089253215581852] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Transposition of the great arteries was once an almost uniformly fatal disease in infancy. Six decades of advances in surgical techniques, intraoperative care, and perioperative management have led to at least 90% of patients reaching adulthood, most with a good quality of life. This review summarizes medical and surgical decision making during the neonatal perioperative period, with a special emphasis on factors pertinent to the anesthetic evaluation and care during primary surgical repair of transposition of the great arteries. A review is also provided of anesthetic considerations for noncardiac surgery later in childhood or adulthood, for those survivors of the arterial switch operation, Rastelli procedure, Nikaidoh procedure, and the réparation á l’étage ventriculaire procedure.
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Affiliation(s)
- Gregory J. Latham
- University of Washington School of Medicine, Seattle, WA, USA
- Seattle Children’s Hospital, Seattle, WA, USA
| | - Denise C. Joffe
- University of Washington School of Medicine, Seattle, WA, USA
- Seattle Children’s Hospital, Seattle, WA, USA
| | - Michael J. Eisses
- University of Washington School of Medicine, Seattle, WA, USA
- Seattle Children’s Hospital, Seattle, WA, USA
| | - Michael J. Richards
- University of Washington School of Medicine, Seattle, WA, USA
- Seattle Children’s Hospital, Seattle, WA, USA
| | - Jeremy M. Geiduschek
- University of Washington School of Medicine, Seattle, WA, USA
- Seattle Children’s Hospital, Seattle, WA, USA
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Lo Rito M, Fittipaldi M, Haththotuwa R, Jones TJ, Khan N, Clift P, Brawn WJ, Barron DJ. Long-term fate of the aortic valve after an arterial switch operation. J Thorac Cardiovasc Surg 2015; 149:1089-94. [DOI: 10.1016/j.jtcvs.2014.11.075] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 10/29/2014] [Accepted: 11/28/2014] [Indexed: 11/25/2022]
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44
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Brister KA, Shores JC, Salazar JD, DiBardino DJ, Wyatt-Ashmead J, Dodge-Khatami A. Recurrent neoaortic insufficiency after the switch back operation with previous repair of transposition with ventricular septal defect and aortic arch hypoplasia. World J Pediatr Congenit Heart Surg 2014; 6:135-8. [PMID: 25548362 DOI: 10.1177/2150135114555375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neoaortic insufficiency is not uncommon after the arterial switch operation (ASO) for d-Transposition, yet surgery is rarely required. In a patient with worsening neoaortic regurgitation post-arterial switch and ventricular septal defect (VSD) closure, we performed a successful "switch back" operation with documented aortic valve competence on discharge echocardiography. However, recurrent severe aortic insufficiency required valve replacement, and histopathology of the excised valve indicated abnormal leaflet/vascular wall structure. We question whether the switch back operation is a viable option for neoaortic insufficiency after an ASO in patients with previous d-Transposition and VSD, when the native pulmonary valve may have structural deficiencies.
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Affiliation(s)
- Kelly A Brister
- Division of Pediatric and Congenital Heart Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Jennifer C Shores
- Division of Pediatric Cardiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Jorge D Salazar
- Division of Pediatric and Congenital Heart Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Daniel J DiBardino
- Division of Pediatric and Congenital Heart Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Josephine Wyatt-Ashmead
- Department of Pathology, Children's Heart Center, University of Mississippi Medical Center, Jackson, MS, USA
| | - Ali Dodge-Khatami
- Division of Pediatric and Congenital Heart Surgery, University of Mississippi Medical Center, Jackson, MS, USA
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Lui GK, Fernandes S, McElhinney DB. Management of cardiovascular risk factors in adults with congenital heart disease. J Am Heart Assoc 2014; 3:e001076. [PMID: 25359401 PMCID: PMC4338694 DOI: 10.1161/jaha.114.001076] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 10/01/2014] [Indexed: 01/21/2023]
Affiliation(s)
- George K Lui
- Divisions of Cardiovascular Medicine and Pediatric Cardiology, Departments of Medicine and Pediatrics, Stanford University School of Medicine, Stanford, CA (G.K.L., S.F.)
| | - Susan Fernandes
- Divisions of Cardiovascular Medicine and Pediatric Cardiology, Departments of Medicine and Pediatrics, Stanford University School of Medicine, Stanford, CA (G.K.L., S.F.)
| | - Doff B McElhinney
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA (D.B.M.E.)
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Villafañe J, Lantin-Hermoso MR, Bhatt AB, Tweddell JS, Geva T, Nathan M, Elliott MJ, Vetter VL, Paridon SM, Kochilas L, Jenkins KJ, Beekman RH, Wernovsky G, Towbin JA. D-transposition of the great arteries: the current era of the arterial switch operation. J Am Coll Cardiol 2014; 64:498-511. [PMID: 25082585 DOI: 10.1016/j.jacc.2014.06.1150] [Citation(s) in RCA: 175] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 06/20/2014] [Indexed: 01/25/2023]
Abstract
This paper aims to update clinicians on "hot topics" in the management of patients with D-loop transposition of the great arteries (D-TGA) in the current surgical era. The arterial switch operation (ASO) has replaced atrial switch procedures for D-TGA, and 90% of patients now reach adulthood. The Adult Congenital and Pediatric Cardiology Council of the American College of Cardiology assembled a team of experts to summarize current knowledge on genetics, pre-natal diagnosis, surgical timing, balloon atrial septostomy, prostaglandin E1 therapy, intraoperative techniques, imaging, coronary obstruction, arrhythmias, sudden death, neoaortic regurgitation and dilation, neurodevelopmental (ND) issues, and lifelong care of D-TGA patients. In simple D-TGA: 1) familial recurrence risk is low; 2) children diagnosed pre-natally have improved cognitive skills compared with those diagnosed post-natally; 3) echocardiography helps to identify risk factors; 4) routine use of BAS and prostaglandin E1 may not be indicated in all cases; 5) early ASO improves outcomes and reduces costs with a low mortality; 6) single or intramural coronary arteries remain risk factors; 7) post-ASO arrhythmias and cardiac dysfunction should raise suspicion of coronary insufficiency; 8) coronary insufficiency and arrhythmias are rare but are associated with sudden death; 9) early- and late-onset ND abnormalities are common; 10) aortic regurgitation and aortic root dilation are well tolerated; and 11) the aging ASO patient may benefit from "exercise-prescription" rather than restriction. Significant strides have been made in understanding risk factors for cardiac, ND, and other important clinical outcomes after ASO.
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Affiliation(s)
- Juan Villafañe
- Department of Pediatrics (Cardiology), University of Kentucky, Lexington, Kentucky.
| | | | - Ami B Bhatt
- Adult Congenital Heart Disease Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - James S Tweddell
- Cardiothoracic Surgery, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Tal Geva
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Meena Nathan
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Martin J Elliott
- Department of Pediatric Cardiothoracic Surgery, The Great Ormond Street Hospital for Children, NHS Foundation Trust, London, United Kingdom
| | - Victoria L Vetter
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen M Paridon
- Department of Exercise Physiology, Perlman School of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Lazaros Kochilas
- University of Minnesota Children's Hospital, Minneapolis, Minnesota
| | - Kathy J Jenkins
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert H Beekman
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Gil Wernovsky
- The Heart Program, Miami Children's Hospital, Florida International University Herbert Wertheim College of Medicine, Miami, Florida
| | - Jeffrey A Towbin
- The Heart Institute, Division of Cardiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Liebrich M, Scheid M, Uhlemann F, Hemmer WB. Valve-sparing reimplantation technique for treatment of neoaortic root dilatation late after the arterial switch operation: raising the bar. Thorac Cardiovasc Surg Rep 2014; 3:16-8. [PMID: 25798352 PMCID: PMC4360663 DOI: 10.1055/s-0034-1387130] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 06/16/2014] [Indexed: 11/12/2022] Open
Abstract
Neoaortic root dilatation can develop during long-term follow-up after an arterial switch operation (ASO). Although few patients require surgical reintervention, significant valve regurgitation is still an important cause of late morbidity. We report on a 15-year-old boy with significant dilatation of the neoaortic root that was treated with the valve-sparing reimplantation technique. There is only one reported case of valve-preserving surgery late after the ASO. Valve preservation is believed to be superior to valve replacement in patients with aortic regurgitation due to better hemodynamic performance and avoidance of anticoagulation therapy.
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Affiliation(s)
- Markus Liebrich
- Department of Cardiac Surgery, Sana Cardiac Surgery Stuttgart, Stuttgart, Germany ; Department of Congenital Cardiac Surgery, Sana Cardiac Surgery Stuttgart, Stuttgart, Germany
| | - Michael Scheid
- Department of Cardiac Surgery, Sana Cardiac Surgery Stuttgart, Stuttgart, Germany ; Department of Congenital Cardiac Surgery, Sana Cardiac Surgery Stuttgart, Stuttgart, Germany
| | - Frank Uhlemann
- Department of Pediatric Cardiology/Pulmonology and Intensive Care Medicine, Klinikum Stuttgart Olgahospital, Stuttgart, Germany
| | - Wolfgang B Hemmer
- Department of Cardiac Surgery, Sana Cardiac Surgery Stuttgart, Stuttgart, Germany ; Department of Congenital Cardiac Surgery, Sana Cardiac Surgery Stuttgart, Stuttgart, Germany
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48
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Koolbergen DR, Manshanden JSJ, Yazdanbakhsh AP, Bouma BJ, Blom NA, de Mol BAJM, Mulder BJ, Hazekamp MG. Reoperation for neoaortic root pathology after the arterial switch operation. Eur J Cardiothorac Surg 2014; 46:474-9; discussion 479. [DOI: 10.1093/ejcts/ezu026] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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