Intervention for Supravalvar Pulmonary Stenosis After the Arterial Switch Operation.
BACKGROUND
The arterial switch operation is standard of care for infants born with dextrotransposition of the great arteries. Supravalvar pulmonary stenosis is a common complication that may require reintervention-balloon angioplasty, stenting, or surgical augmentation. A subset of patients requires more than one reintervention.


METHODS
We performed a retrospective review of patients who underwent the arterial switch operation for dextrotransposition of the great arteries at a single institution between August 1990 and January 2014. Anatomic, perioperative and follow-up data were collected. Reinterventions were stratified in a site-specific manner. Statistical analysis was performed using IBM SPSS version 21 (IBM Corp, Armonk, NY).


RESULTS
Of the 103 patients who met inclusion criteria, 28% (29) required reintervention for supravalvar pulmonary stenosis; 41% of those receiving primary reintervention required an additional 21 reinterventions. Balloon angioplasty of the main pulmonary artery and left pulmonary artery was associated with the need for multiple reinterventions (odds ratio 4.9, p = 0.051, and odds ratio 5.1, p = 0.029, respectively). Freedom from future reintervention at the main pulmonary artery and left pulmonary artery was significantly shorter after balloon angioplasty relative to alternative reintervention options (hazard ratio 10, p = 0.005, and hazard ratio 3.2, p = 0.02, respectively). Balloon angioplasty of the right pulmonary artery was not associated with an increased risk of reintervention (p = 0.42).


CONCLUSIONS
Supravalvar pulmonary stenosis after the arterial switch operation for dextrotransposition of the great arteries is common and more than one reintervention are required in a subset of patients. The benefit of balloon angioplasty of the main pulmonary artery and left pulmonary artery was shown to be temporary. Attempting balloon angioplasties at these locations remain reasonable, although families should be counseled about the increased incidence of, and decreased time to, subsequent reintervention that is associated with this treatment option.
University of Iowa Carver College of Medicine, Iowa City, Iowa.
Joseph R
JR
Nellis
Division of Pediatric Cardiac Surgery, University of Iowa Children's Hospital, Iowa City, Iowa. Electronic address: joseph-turek@uiowa.edu.
Joseph W
JW
Turek
Division of Pediatric Cardiology, University of Iowa Children's Hospital, Iowa City, Iowa.
Osamah T
OT
Aldoss
Division of Pediatric Cardiology, University of Iowa Children's Hospital, Iowa City, Iowa.
Dianne L
DL
Atkins
Division of Pediatric Cardiology, University of Iowa Children's Hospital, Iowa City, Iowa.
Benton Y
BY
Ng
D000792:Angiography; D000800:Angioplasty, Balloon / Q000379:methods*; D000069278:Arterial Switch Operation / Q000009:adverse effects*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D011666:Pulmonary Valve Stenosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D014188:Transposition of Great Vessels / Q000601:surgery*; D016896:Treatment Outcome