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Nguyen MT, Doan AV, Tran VQ, Mai DD, Nguyen UH, Nguyen TLT. The Arterial Switch Operation in the Developing World: Risk Factors and Current Outcomes. Ann Thorac Surg 2024; 117:543-549. [PMID: 37595862 DOI: 10.1016/j.athoracsur.2023.07.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Published data on the outcomes of the arterial switch operation in the developing world are limited. We sought to identify the midterm outcomes of and risk factors for mortality and morbidity in patients undergoing the arterial switch operation at a high-volume center in Vietnam. METHODS A retrospective review was conducted of 608 patients who underwent an arterial switch operation for the treatment of transposition of the great arteries (TGA; n = 509) or double-outlet right ventricle TGA (DORV-TGA; n = 99) at a single center from 2010 to 2021. RESULTS Overall early mortality was 5.9%, and late mortality was 1%. Multivariate Cox regression showed weight at operation of <3 kg (P < .001), prolonged aortic cross-clamp time (P < .001), and need for secondary aortic cross-clamp (P = .011) as risk factors for overall mortality. The actuarial 10-year survival rate was 93%. The overall cardiac reoperation rate was significantly higher in patients with DORV-TGA (hazard ratio [HR], 16.43; 95% CI, 4.70-57.43; P < .001). The rate of freedom from cardiac reoperation at 10 years was 94%. Risk factors for outflow tract reoperation were patients with DORV-TGA (HR, 23.28; 95% CI, 2.86-189.66; P = .003), single coronary artery (HR, 4.1; 95% CI, 1.16-14.46; P = .028), and mild aortic valve regurgitation observed in 3.7% of patients. CONCLUSIONS The outcomes of the arterial switch operation in a low- and middle-income country were satisfactory. Nevertheless, the complexity of the procedure and lower weight of patients are still challenges. Patients with DORV-TGA and single coronary artery need to be closely followed up.
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Affiliation(s)
- Mai Tuan Nguyen
- Department of Cardiovascular Surgery, Heart Center, Vietnam National Children's Hospital, Hanoi, Vietnam; Department of Surgery, Hanoi Medical University, Hanoi, Vietnam
| | - Anh Vuong Doan
- Department of Cardiovascular Surgery, Heart Center, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Vinh Quang Tran
- Department of Cardiovascular Surgery, Heart Center, Vietnam National Children's Hospital, Hanoi, Vietnam; Department of Surgery, Hanoi Medical University, Hanoi, Vietnam
| | - Duyen Dinh Mai
- Department of Cardiovascular Surgery, Heart Center, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Uoc Huu Nguyen
- Department of Surgery, Hanoi Medical University, Hanoi, Vietnam
| | - Truong Ly Thinh Nguyen
- Department of Cardiovascular Surgery, Heart Center, Vietnam National Children's Hospital, Hanoi, Vietnam.
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Dorobantu DM, Espuny Pujol F, Kostolny M, Brown KL, Franklin RC, Crowe S, Pagel C, Stoica SC. Arterial Switch for Transposition of the Great Arteries: Treatment Timing, Late Outcomes, and Risk Factors. JACC. ADVANCES 2023; 2:100407. [PMID: 38939004 PMCID: PMC11198700 DOI: 10.1016/j.jacadv.2023.100407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/23/2023] [Accepted: 04/06/2023] [Indexed: 06/29/2024]
Abstract
Background Reports of long-term mortality and reintervention after transposition of the great arteries with intact ventricular septum treatment, although favorable, are mostly limited to single-center studies. Even less is known about hospital resource utilization (days at hospital) and the impact of treatment choices and timing on outcomes. Objectives The purpose of this study was to describe survival, reintervention and hospital resource utilization after arterial switch operation (ASO) in a national dataset. Methods Follow-up and life status data for all patients undergoing ASO between 2000 and 2017 in England and Wales were collected and explored using multivariable regressions and matching. Results A total of 1,772 patients were identified, with median ASO age of 9.5 days (IQR: 6.5-14.5 days). Mortality and cardiac reintervention at 10 years after ASO were 3.2% (95% CI: 2.5%-4.2%) and 10.7% (95% CI: 9.1%-12.2%), respectively. The median time spent in hospital during the ASO spell was 19 days (IQR: 14, 24). Over the first year after the ASO patients spent 7 days (IQR: 4-10 days) in hospital in total, decreasing to 1 outpatient day/year beyond the fifth year. In a subgroup with complete risk factor data (n = 652), ASO age, and balloon atrial septostomy (BAS) use were not associated with late mortality and reintervention, but cardiac or congenital comorbidities, low weight, and circulatory/renal support at ASO were. After matching for patient characteristics, BAS followed by ASO and ASO as first procedure, performed within the first 3 weeks of life, had comparable early and late outcomes, including hospital resource utilization. Conclusions Mortality and hospital resource utilization are low, while reintervention remains relatively frequent. Early ASO and individualized use of BAS allows for flexibility in treatment choices and a focus on at-risk patients.
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Affiliation(s)
- Dan-Mihai Dorobantu
- Children's Health and Exercise Research Centre (CHERC), University of Exeter, Exeter, United Kingdom
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Cardiology Department, University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, United Kingdom
| | - Ferran Espuny Pujol
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, United Kingdom
| | - Martin Kostolny
- Heart and Lung Division, Great Ormond Street Hospital NIHR Biomedical Research Centre, London, United Kingdom
| | - Katherine L. Brown
- Heart and Lung Division, Great Ormond Street Hospital NIHR Biomedical Research Centre, London, United Kingdom
| | - Rodney C. Franklin
- Department of Paediatric Cardiology, Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Sonya Crowe
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, United Kingdom
| | - Christina Pagel
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, United Kingdom
| | - Serban C. Stoica
- Cardiology Department, University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, United Kingdom
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Stephens A, McKenzie D, Heinle J, Melicoff-Portillo E, Gazzaneo C, Coleman R, Adachi I. Central extracorporeal membrane oxygenation to lung transplantation after remote arterial switch operation. JTCVS Tech 2021; 10:452-455. [PMID: 34977782 PMCID: PMC8690869 DOI: 10.1016/j.xjtc.2021.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/30/2021] [Indexed: 11/05/2022] Open
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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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Grown-up Congenital Heart Surgery in 1093 Consecutive Cases: A "Hidden" Burden of Early Outcome. Ann Thorac Surg 2020; 110:1667-1676. [PMID: 32147413 DOI: 10.1016/j.athoracsur.2020.01.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 01/13/2020] [Accepted: 01/24/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Surgery in grown-ups with congenital heart disease (GUCH) is characterized by complex anatomy, comorbidities, reoperations, and technical challenges. Although 30-day postoperative mortality is low, this measure might be insufficient to reflect adverse outcome monitoring. Our study aimed to establish whether prolonged intensive care unit (ICU) stay (≥7 days) and 6-month mortality were more clinically meaningful measures than 30-day mortality and to identify predictors of adverse outcome. METHODS All consecutive GUCH patients from 1998 to 2015 were identified. Perioperative characteristics, diagnoses, and postoperative data were collected retrospectively. Predictors of 30-day and 6-month mortality and prolonged ICU stay were determined with logistic regression. Era effect was tested for quality assurances by dividing the cohort into 4 time intervals. RESULTS Within 17 years, 1093 consecutive cardiac surgical procedures were identified in 1026 GUCH patients. During the study period, 30-day mortality improved significantly, with an overall 30-day mortality of 1.5%; 6-month mortality and prolonged ICU stay were 2.4% and 6.7%, respectively. Despite a decreased number of preoperative patients in New York Heart Association Functional Classification III or higher, prolonged ICU stay increased over the eras. Predictors of adverse outcome were New York Heart Association class III or higher, preoperative renal failure, disease of great complexity, preoperative ventilator support, cardiopulmonary bypass time, and concomitant procedures. CONCLUSIONS In the current era of low 30-day mortality, extended 6-month mortality and prolonged ICU stay reporting may be more realistic measures of adverse outcomes for counseling GUCH patients at risk.
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Martens T, Kostolny M, Spencer H, Muthialu N. Technical challenges of lung transplantation in children after arterial switch operation. Interact Cardiovasc Thorac Surg 2019; 28:493-495. [PMID: 30107403 DOI: 10.1093/icvts/ivy253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/10/2018] [Accepted: 07/16/2018] [Indexed: 11/12/2022] Open
Abstract
Pulmonary arterial hypertension after arterial switch operation for transposition of the great arteries is rare. Lung transplantation can be the last option in cases of failed medical therapy. We report 2 paediatric patients who underwent lung transplantation for this indication. Altered hilar anatomy, mediastinal adhesions and haemostatic control represent the main technical challenges. Volume-reduction surgery is sometimes necessary to address altered cardiopulmonary relationships while expanding the donor pool.
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Affiliation(s)
- Thomas Martens
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Department of Cardiac Surgery, University Hospital Ghent, Ghent, Belgium
| | - Martin Kostolny
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Slovak Medical University, Bratislava, Slovakia
| | - Helen Spencer
- Department of Transplantation, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Nagarajan Muthialu
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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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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Lammers AE, Bauer UMM. Pulmonary hypertension after timely arterial switch operation in children with simple transposition of the great arteries: a new disease entity? Heart 2017; 103:1227-1228. [PMID: 28302684 DOI: 10.1136/heartjnl-2016-311105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Astrid E Lammers
- Department of Paediatric Cardiology, University Hospital Münster, Münster, Germany
| | - Ulrike M M Bauer
- National Register for Congenital Heart Defects, DZHK (German Centre for Cardiovascular Research), Berlin, Germany
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