title: Reoperative techniques for complications after arterial switch.
abstract: BACKGROUND
  The purpose of this study is to review our experience with late reoperations after the arterial switch operation (ASO) and to introduce reparative solutions adapted from previous techniques.
  
  
  METHODS
  A retrospective study was performed on 23 patients who underwent late reoperations after ASO between 1983 and 2010. Eighteen patients were from our concomitantly reported cohort of 258 ASO patients and 5 came from distant referrals.
  
  
  RESULTS
  Twenty-seven reoperations on 23 patients were performed for lesions relating to coronary arteries (9 procedures, 7 patients), the neoaortic root (12 procedures, 10 patients), and the right ventricular outflow tract (6 procedures, 6 patients). Four patients died: 1 from an exsanguinating gastric ulcer 4 years after prosthetic valve replacement; 1 from coronary occlusion one month postoperatively from an unroofed intramural left main coronary artery; and 2 after supravalvar pulmonary artery stenosis repair complicated by coexisting left ventricular dysfunction from the original ASO.
  
  
  CONCLUSIONS
  The ASO remains the treatment of choice for transposition of the great arteries and its variants. While the incidence of late reintervention is low, a subset of patients will require operations that extend the principles of myocardial revascularization, left ventricular outflow tract reconstruction, and relief of pulmonary stenosis.
authors.affiliation: Department of Pediatric and Congenital Heart Surgery, Cleveland Clinic Children's Hospital, Cleveland, Ohio 44195, USA. mavrouc@ccf.org
authors.forename: Constantine
authors.initials: C
authors.lastname: Mavroudis
authors.forename: Robert D
authors.initials: RD
authors.lastname: Stewart
authors.forename: Carl L
authors.initials: CL
authors.lastname: Backer
authors.forename: Harish
authors.initials: H
authors.lastname: Rudra
authors.forename: Patrick
authors.initials: P
authors.lastname: Vargo
authors.forename: Marshall L
authors.initials: ML
authors.lastname: Jacobs
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D002648:Child; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D014188:Transposition of Great Vessels / Q000601:surgery*