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Selcuk A, Ozturk M, Tongut A, Sterzbecher V, Park IH, Mehta R, Desai M, Yerebakan C, d'Udekem Y. Excellent Survival With a Focus on Pulmonary Artery Reinterventions After the Arterial Switch Operation. World J Pediatr Congenit Heart Surg 2024; 15:421-429. [PMID: 38751363 DOI: 10.1177/21501351241239307] [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: 07/27/2024]
Abstract
Background: We sought to evaluate the outcomes in patients who underwent the arterial switch operation (ASO) over a 20-year period at a single institution. Methods: The current study is a retrospective review of 180 consecutive patients who underwent the ASO for biventricular surgical correction of dextro-transposition of the great arteries (d-TGA) between 2002 and 2022. Results: Among 180 patients, 121 had TGA-intact ventricular septum, 47 had TGA-ventricular septal defect and 12 had Taussig-Bing Anomaly (TBA). The median follow-up time was 6.7 years (interquartile range: 3.9-8.7 years). There were five early (2.8%) and one late (0.6%) mortality. Survival was 96.6% at one year and beyond. Reoperations were performed in 31 patients (17%). Taussig Bing Anomaly was found to increase the risk of reoperation by 17 times (P < .0001). A total of 37 (21%) patients underwent 53 reinterventions (14 surgical procedures, 39 catheter interventions) specifically addressing pulmonary artery (PA) stenosis. Freedom from PA reintervention was 97%, 87%, 70%, and 55% at 1, 5, 10, and 15 years, respectively. By bivariable analysis, TBA (P = .003, odds ratio [OR]: 6.4, 95% confidence interval [CI]: 1.9-21.7), mild PA stenosis at discharge (P ≤ .001, OR: 6.1, 95% CI: 2.7-13.6), and moderate or severe PA stenosis at discharge (P ≤ .001, OR: 12.7, 95% CI: 5-32.2) were identified as predictors of reintervention on PA. In the last follow-up of 174 survivors, 24 patients (14%) had moderate or greater PA stenosis, two (1%) had moderate neoaortic valve regurgitation, and 168 were New York Heart Association status I. Conclusions: Our results demonstrated excellent survival and functional status following the ASO for d-TGA; however, patients remain subject to frequent reinterventions especially on the pulmonary arteries.
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Affiliation(s)
- Arif Selcuk
- Division of Cardiac Surgery, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Mahmut Ozturk
- Division of Cardiac Surgery, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Aybala Tongut
- Division of Cardiac Surgery, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Vanessa Sterzbecher
- Division of Cardiac Surgery, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - In Hye Park
- Division of Cardiac Surgery, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Rittal Mehta
- Division of Cardiac Surgery, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Manan Desai
- Division of Cardiac Surgery, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Can Yerebakan
- Division of Cardiac Surgery, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Yves d'Udekem
- Division of Cardiac Surgery, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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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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Miller S, Kozik D, Kurtz JD. Prevalence of Branch Pulmonary Artery Reintervention Following the Arterial Switch Operation. World J Pediatr Congenit Heart Surg 2024; 15:60-64. [PMID: 37609811 DOI: 10.1177/21501351231190921] [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: 08/24/2023]
Abstract
BACKGROUND The arterial switch operation (ASO) is the preferred surgical procedure used to correct dextro-transposition of the great arteries. A known complication of the ASO is branch pulmonary arteries (PAs) stenosis, which may require reintervention. Our goal is to determine the frequency of reintervention after the ASO and any factors associated with reintervention. METHODS This was a single center, retrospective study of infants who underwent the ASO from June 6, 2011 to February 21, 2021. The primary outcome was the prevalence of reintervention on the PAs following the ASO. RESULTS Sixty-eight infants were analyzed; 9 (13%) patients had 10 reinterventions. The mean age at time of the ASO was 6.52 ± 6.63 days; weight was 3.34 ± 0.57 kg. Those with a reintervention had a longer bypass time (P = .047). Mean age at reintervention was 0.80 ± 0.72 years; mean time from the ASO to reintervention was 0.799 ± 0.717 years. Six surgical procedures, two stent placements, and four balloon angioplasties were performed on a total of 13 branch PAs. There was no increased risk for reintervention on the right versus left PA. After reintervention, there was an improvement in the minimal PA diameter and echo gradient. There were no adverse events or mortality related to the reintervention. Mean follow-up was 6.17 ± 2.94 years. CONCLUSION The prevalence of branch PA reintervention following the ASO in our cohort was 13%. There is an association between longer cardiopulmonary bypass time and reintervention. After reintervention, there was an increase in PA diameter and a decrease in echo gradient.
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Affiliation(s)
- Samantha Miller
- School of Medicine, University of Louisville, Louisville, KY, USA
| | - Deborah Kozik
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY, USA
| | - Joshua D Kurtz
- Division of Pediatric Cardiology, Department of Pediatrics, University of Louisville, Louisville, KY, USA
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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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Salve GG, Edington AK, Vijayaraghavan A, Betts KS, Ayer JG, Ramakrishnan K, Winlaw DS, Orr Y, Nicholson IA. Technique of coronary button transfer has no impact on neoaortic root size in simple transposition. Semin Thorac Cardiovasc Surg 2022; 35:377-386. [DOI: 10.1053/j.semtcvs.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 11/11/2022]
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Herbst C. The Arterial Switch Operation-Not the End of the Story?! World J Pediatr Congenit Heart Surg 2021; 12:471-472. [PMID: 34278864 DOI: 10.1177/21501351211018202] [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]
Affiliation(s)
- Claudia Herbst
- Department of Cardiac Surgery and Pediatric Heart Center, 27271Medical University Vienna, Vienna, Austria
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Alsaied T, Ashfaq A. From Other Journals: A Review of Recent Articles by Our Editorial Team. Pediatr Cardiol 2021; 42:1884-1889. [PMID: 34515829 PMCID: PMC8436190 DOI: 10.1007/s00246-021-02729-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 11/01/2022]
Abstract
In this review we provide a brief description of recently published articles addressing topics relevant to pediatric cardiologists. Our hope is to provide a summary of the latest articles published recently in other journals in our field. The articles address (1) a summary of a scientific statement of the American Heart Association for diagnosis and treatment of myocarditis, (2) development of a perioperative risk score for in-hospital mortality after cardiac surgery in adults with congenital heart disease, (3) using a machine learning algorithm to predict cardiopulmonary deterioration in patients in the interstage period 1-2 h in advance using hospital monitor generated data, (4) risk factors for reoperation after the arterial switch operation, (5) the effect of mitochondrial transplantation for cardiogenic shock in pediatric patients, (6) comparing outcomes of primary or staged repair in tetralogy of Fallot with pulmonary atresia.
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Affiliation(s)
- Tarek Alsaied
- Pittsburgh Children's Hospital Medical Center, Heart Institute, 3333 Burnet Avenue, Pittsburgh, PA, USA. .,Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Awais Ashfaq
- grid.413611.00000 0004 0467 2330Heart Institute, Johns Hopkins All Children’s All Children’s Hospital, St. Petersburg, FL USA
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