Reoperations and catheter interventions in patients with transposition of the great arteries after the arterial switch operation.
OBJECTIVE
Reoperations and catheter interventions after the arterial switch operation (ASO) are relatively rare, but their frequency varies among different centres. They significantly impact the postoperative course of children with transposition of the great arteries (TGA). The aim of this study was to assess the frequency of reoperations and catheter interventions in patients with TGA after the ASO and to identify the potential risk factors.


METHODS
For this retrospective case review study we included all consecutive 715 patients with TGA who underwent the ASO in the Department of Cardiac Surgery between the years 1991 and 2015. All of the surgical procedures were performed by one cardiac surgery team led by J.J.M., using the same surgical technique with his own specific modifications.


RESULTS
The overall early mortality after the ASO was 7.4%; late mortality occurred in 15 cases (2.3%) and the mean clinical follow-up of our cohort was 10.5 years. Early reoperations (<30 days after surgery) were performed in 37 patients (5.1%). Reoperations were performed in 31 patients (4.7% of survivors), and their risk factors were previous early reoperation and left ventricle outflow tract obstruction, while isolated TGA reduced the risk of reoperations. Catheter interventions were performed in 25 patients (3.8% of survivors). In the majority of the cases, the indications for percutaneous procedures were pulmonary stenosis and recoarctation of the aorta. The statistically significant risk factors were aortic arch anomalies associated with TGA and neopulmonary artery anastomosis with a patch, while isolated TGA decreased the risk of reintervention. Freedom from cumulative reinterventions after the ASO was 90.4% at 5 years; 88.0% at 10 years; 86.5% at 15 years and 86.5% from 20 to 25 years.


CONCLUSIONS
The frequency of reoperations and percutaneous interventions in patients with TGA after the ASO remains low. The majority of the procedures are performed because of pulmonary stenosis and recoarctation of aorta. Cardiac anomalies associated with TGA have a significant impact on the incidence of reoperation and reintervention.
Department of Cardiology, Polish Mother's Memorial Hospital, Lodz, Poland krzysiekmichalak@interia.pl.
Krzysztof W
KW
Michalak
Department of Cardiology, Polish Mother's Memorial Hospital, Lodz, Poland.
Jadwiga A
JA
Moll
Department of Cardiology, Polish Mother's Memorial Hospital, Lodz, Poland.
Katarzyna
K
Sobczak-Budlewska
Department of Cardiac Surgery, Polish Mother's Memorial Hospital, Lodz, Poland.
Maciej
M
Moll
Department of Cardiology, Polish Mother's Memorial Hospital, Lodz, Poland.
Paweł
P
Dryżek
Department of Cardiology, Polish Mother's Memorial Hospital, Lodz, Poland.
Tomasz
T
Moszura
Department of Diagnostic Imaging, Polish Mother's Memorial Hospital, Lodz, Poland.
Konrad
K
Szymczyk
Department of Cardiac Surgery, Polish Mother's Memorial Hospital, Lodz, Poland.
Jacek J
JJ
Moll
D000293:Adolescent; D000069278:Arterial Switch Operation / Q000009:adverse effects* / Q000379:methods; D006328:Cardiac Catheterization / Q000379:methods* / Q000706:statistics & numerical data; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D011044:Poland / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014188:Transposition of Great Vessels / Q000401:mortality / Q000601:surgery*
Arterial switch operation; Catheter reinterventions; Outcome; Reoperations; Transposition of the great arteries