title: Reoperation after arterial switch: a 27-year experience.
abstract: BACKGROUND
  The long-term outcome and spectrum of reoperation after the arterial switch operation (ASO) has not been fully defined, and there are limited data in the literature. We reviewed our institutional experience with reoperation(s) after ASO.
  
  
  METHODS
  Between January 1984 and January 2012, 32 patients (23 male) underwent reoperation(s) after ASO. Anatomy included simple transposition of the great arteries in 14, complex transposition of the great arteries in 14, and Taussig-Bing in 4. Mean age was 6.7 ± 1.4 years at first operation and 10.8 ± 13.4 years at the second operation. Isolated pathology was present in 11 (34.3%) and multiple pathologies in 21 (65.6%). Abnormalities at first reoperation were right-sided pathology in 18 (56.3%), left-sided pathology in 10 (31%), coronary artery in 3 (9%), mitral valve in 3 (9%), residual ventricular septal defect in 4 (12.5%), and recoarctation in 2 (6.3%). It was the second reoperation in 12 and the third reoperation in 3 patients.
  
  
  RESULTS
  The first reoperation included pulmonary artery patch plasty in 18, aortic valve operation in 8 (4 valve replacement, 3 root replacement, and 1 repair), pulmonary valve replacement in 4, coronary artery bypass grafting in 3, and mitral valve repair in 3. Multiple reoperations occurred in 15 patients, comprising right-sided procedures (11), left-sided (2), and other (2). Pulmonary artery reconstruction occurred earlier than neoaortic intervention (5.4 ± 6.8 vs 13.8 ± 7.7 years, p < 0.001). There were 2 early deaths (6.2%); both patients had complex transposition of the great arteries and both were at early reoperation after ASO. Median follow-up was 14.5 years (maximum, 27 years). There were no late deaths. Freedom from reoperation at 1, 5, and 15 years was 88%, 78%, and 41%, respectively.
  
  
  CONCLUSIONS
  The most common indication for reoperation after ASO is right-sided pathology, followed by neoaortic root pathology. Late survival after ASO is excellent and risk of late reoperation is low. Life-long medical surveillance is required.
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Vijayakumar
authors.initials: V
authors.lastname: Raju
authors.forename: Harold M
authors.initials: HM
authors.lastname: Burkhart
authors.forename: Lucian A
authors.initials: LA
authors.lastname: Durham
authors.forename: Benjamin W
authors.initials: BW
authors.lastname: Eidem
authors.forename: Sabrina D
authors.initials: SD
authors.lastname: Phillips
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Li
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Dearani
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000367:Age Factors; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D012086:Reoperation / Q000379:methods* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D015996:Survival Rate; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult