Left-Sided Reoperations After Arterial Switch Operation: A European Multicenter Study

Vladimiro L Vida; Lorenza Zanotto; Lucia Zanotto; Giovanni Stellin; Massimo Padalino; Georges Sarris; Eleftherios Protopapas; Carol Prospero; Christian Pizarro; Edward Woodford; Thomas Tlaskal; Hakan Berggren; Martin Kostolny; Ikenna Omeje; Boulos Asfour; Alexander Kadner; Thierry Carrel; Paul H Schoof; Matej Nosal; Josè Fragata; Michał Kozłowski; Bohdan Maruszewski; Luca A Vricella; Duke E Cameron; Vladimir Sojak; Mark G. Hazekamp; Jukka Salminen; Ilkka P Mattila; Julie Cleuziou; Patrick O Myers; Viktor Hraska

doi:10.1016/j.athoracsur.2017.04.026

Left-Sided Reoperations After Arterial Switch Operation: A European Multicenter Study

Vladimiro L Vida, Lorenza Zanotto, Lucia Zanotto, Giovanni Stellin, Massimo Padalino, Georges Sarris, Eleftherios Protopapas, Carol Prospero, Christian Pizarro, Edward Woodford, Thomas Tlaskal, Hakan Berggren, Martin Kostolny, Ikenna Omeje, Boulos Asfour, Alexander Kadner, Thierry Carrel, Paul H Schoof, Matej Nosal, Josè FragataMichał Kozłowski, Bohdan Maruszewski, Luca A Vricella, Duke E Cameron, Vladimir Sojak, Mark G. Hazekamp, Jukka Salminen, Ilkka P Mattila, Julie Cleuziou, Patrick O Myers, Viktor Hraska,

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: We sought to report the frequency, types, and outcomes of left-sided reoperations (LSRs) after an arterial switch operation (ASO) for patients with D-transposition of the great arteries (D-TGA) and double-outlet right ventricle (DORV) TGA-type.

METHODS: Seventeen centers belonging to the European Congenital Heart Surgeons Association (ECHSA) contributed to data collection. We included 111 patients who underwent LSRs after 7,951 ASOs (1.4%) between January 1975 and December 2010. Original diagnoses included D-TGA (n = 99) and DORV TGA-type (n = 12). Main indications for LSR were neoaortic valve insufficiency (n = 52 [47%]) and coronary artery problems (CAPs) (n = 21 [19%]).

RESULTS: Median age at reoperation was 8.2 years (interquartile range [IQR], 2.9-14 years). Seven patients died early after LSRs (6.3%); 4 patients with D-TGA (5.9%) and 3 patients with DORV TGA-type (25%) (p = 0.02). Median age at last follow-up was 16.1 years (IQR, 9.9-21.8 years). Seventeen patients (16%) required another reoperation, which was more frequent in patients with DORV- TGA type (4 of 9 [45%]) than in patients with D-TGA (13 of 95 [14%]). Late death occurred in 4 patients (4 of 104 [3.8%]). The majority of survivors were asymptomatic at last clinical examination (84 of 100 [84%]).

CONCLUSIONS: Reoperations for residual LSRs are infrequent but may become necessary late after an ASO, predominantly for neoaortic valve insufficiency and CAPs. Risk at reoperation is not negligible, and DORV TGA-type anatomy, as well as procedures on the coronary arteries, were significantly associated with a higher morbidity and a lower overall survival. Recurrent reoperations after LSRs may be required.

Original language	English
Pages (from-to)	899-906
Number of pages	8
Journal	Annals of Thoracic Surgery
Volume	104
Issue number	3
DOIs	https://doi.org/10.1016/j.athoracsur.2017.04.026
Publication status	Published - Sept 2017

Keywords

Adolescent
Aortic Valve Insufficiency
Arterial Switch Operation
Child
Child, Preschool
Double Outlet Right Ventricle
Europe
Female
Follow-Up Studies
Humans
Incidence
Infant
Journal Article
Male
Multicenter Study
Postoperative Complications
Prognosis
Reoperation
Retrospective Studies
Risk Factors
Survival Rate
Transposition of Great Vessels

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10.1016/j.athoracsur.2017.04.026

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Vida, V. L., Zanotto, L., Zanotto, L., Stellin, G., Padalino, M., Sarris, G., Protopapas, E., Prospero, C., Pizarro, C., Woodford, E., Tlaskal, T., Berggren, H., Kostolny, M., Omeje, I., Asfour, B., Kadner, A., Carrel, T., Schoof, P. H., Nosal, M. (2017). Left-Sided Reoperations After Arterial Switch Operation: A European Multicenter Study. Annals of Thoracic Surgery, 104(3), 899-906. https://doi.org/10.1016/j.athoracsur.2017.04.026

@article{8c391c2f21b64cd980c8c841322c4efd,

title = "Left-Sided Reoperations After Arterial Switch Operation: A European Multicenter Study",

abstract = "BACKGROUND: We sought to report the frequency, types, and outcomes of left-sided reoperations (LSRs) after an arterial switch operation (ASO) for patients with D-transposition of the great arteries (D-TGA) and double-outlet right ventricle (DORV) TGA-type.METHODS: Seventeen centers belonging to the European Congenital Heart Surgeons Association (ECHSA) contributed to data collection. We included 111 patients who underwent LSRs after 7,951 ASOs (1.4%) between January 1975 and December 2010. Original diagnoses included D-TGA (n = 99) and DORV TGA-type (n = 12). Main indications for LSR were neoaortic valve insufficiency (n = 52 [47%]) and coronary artery problems (CAPs) (n = 21 [19%]).RESULTS: Median age at reoperation was 8.2 years (interquartile range [IQR], 2.9-14 years). Seven patients died early after LSRs (6.3%); 4 patients with D-TGA (5.9%) and 3 patients with DORV TGA-type (25%) (p = 0.02). Median age at last follow-up was 16.1 years (IQR, 9.9-21.8 years). Seventeen patients (16%) required another reoperation, which was more frequent in patients with DORV- TGA type (4 of 9 [45%]) than in patients with D-TGA (13 of 95 [14%]). Late death occurred in 4 patients (4 of 104 [3.8%]). The majority of survivors were asymptomatic at last clinical examination (84 of 100 [84%]).CONCLUSIONS: Reoperations for residual LSRs are infrequent but may become necessary late after an ASO, predominantly for neoaortic valve insufficiency and CAPs. Risk at reoperation is not negligible, and DORV TGA-type anatomy, as well as procedures on the coronary arteries, were significantly associated with a higher morbidity and a lower overall survival. Recurrent reoperations after LSRs may be required.",

keywords = "Adolescent, Aortic Valve Insufficiency, Arterial Switch Operation, Child, Child, Preschool, Double Outlet Right Ventricle, Europe, Female, Follow-Up Studies, Humans, Incidence, Infant, Journal Article, Male, Multicenter Study, Postoperative Complications, Prognosis, Reoperation, Retrospective Studies, Risk Factors, Survival Rate, Transposition of Great Vessels",

author = "Vida, {Vladimiro L} and Lorenza Zanotto and Lucia Zanotto and Giovanni Stellin and Massimo Padalino and Georges Sarris and Eleftherios Protopapas and Carol Prospero and Christian Pizarro and Edward Woodford and Thomas Tlaskal and Hakan Berggren and Martin Kostolny and Ikenna Omeje and Boulos Asfour and Alexander Kadner and Thierry Carrel and Schoof, {Paul H} and Matej Nosal and Jos{\`e} Fragata and Micha{\l} Koz{\l}owski and Bohdan Maruszewski and Vricella, {Luca A} and Cameron, {Duke E} and Vladimir Sojak and Hazekamp, {Mark G.} and Jukka Salminen and Mattila, {Ilkka P} and Julie Cleuziou and Myers, {Patrick O} and Viktor Hraska",

note = "Publisher Copyright: {\textcopyright} 2017 The Society of Thoracic Surgeons",

year = "2017",

month = sep,

doi = "10.1016/j.athoracsur.2017.04.026",

language = "English",

volume = "104",

pages = "899--906",

journal = "Annals of Thoracic Surgery",

issn = "0003-4975",

publisher = "Elsevier",

number = "3",

}

Vida, VL, Zanotto, L, Zanotto, L, Stellin, G, Padalino, M, Sarris, G, Protopapas, E, Prospero, C, Pizarro, C, Woodford, E, Tlaskal, T, Berggren, H, Kostolny, M, Omeje, I, Asfour, B, Kadner, A, Carrel, T, Schoof, PH, Nosal, M, Fragata, J, Kozłowski, M, Maruszewski, B, Vricella, LA, Cameron, DE, Sojak, V, Hazekamp, MG, Salminen, J, Mattila, IP, Cleuziou, J, Myers, PO, Hraska, V 2017, 'Left-Sided Reoperations After Arterial Switch Operation: A European Multicenter Study', Annals of Thoracic Surgery, vol. 104, no. 3, pp. 899-906. https://doi.org/10.1016/j.athoracsur.2017.04.026

TY - JOUR

T1 - Left-Sided Reoperations After Arterial Switch Operation

T2 - A European Multicenter Study

AU - Vida, Vladimiro L

AU - Zanotto, Lorenza

AU - Zanotto, Lucia

AU - Stellin, Giovanni

AU - Padalino, Massimo

AU - Sarris, Georges

AU - Protopapas, Eleftherios

AU - Prospero, Carol

AU - Pizarro, Christian

AU - Woodford, Edward

AU - Tlaskal, Thomas

AU - Berggren, Hakan

AU - Kostolny, Martin

AU - Omeje, Ikenna

AU - Asfour, Boulos

AU - Kadner, Alexander

AU - Carrel, Thierry

AU - Schoof, Paul H

AU - Nosal, Matej

AU - Fragata, Josè

AU - Kozłowski, Michał

AU - Maruszewski, Bohdan

AU - Vricella, Luca A

AU - Cameron, Duke E

AU - Sojak, Vladimir

AU - Hazekamp, Mark G.

AU - Salminen, Jukka

AU - Mattila, Ilkka P

AU - Cleuziou, Julie

AU - Myers, Patrick O

AU - Hraska, Viktor

PY - 2017/9

Y1 - 2017/9

N2 - BACKGROUND: We sought to report the frequency, types, and outcomes of left-sided reoperations (LSRs) after an arterial switch operation (ASO) for patients with D-transposition of the great arteries (D-TGA) and double-outlet right ventricle (DORV) TGA-type.METHODS: Seventeen centers belonging to the European Congenital Heart Surgeons Association (ECHSA) contributed to data collection. We included 111 patients who underwent LSRs after 7,951 ASOs (1.4%) between January 1975 and December 2010. Original diagnoses included D-TGA (n = 99) and DORV TGA-type (n = 12). Main indications for LSR were neoaortic valve insufficiency (n = 52 [47%]) and coronary artery problems (CAPs) (n = 21 [19%]).RESULTS: Median age at reoperation was 8.2 years (interquartile range [IQR], 2.9-14 years). Seven patients died early after LSRs (6.3%); 4 patients with D-TGA (5.9%) and 3 patients with DORV TGA-type (25%) (p = 0.02). Median age at last follow-up was 16.1 years (IQR, 9.9-21.8 years). Seventeen patients (16%) required another reoperation, which was more frequent in patients with DORV- TGA type (4 of 9 [45%]) than in patients with D-TGA (13 of 95 [14%]). Late death occurred in 4 patients (4 of 104 [3.8%]). The majority of survivors were asymptomatic at last clinical examination (84 of 100 [84%]).CONCLUSIONS: Reoperations for residual LSRs are infrequent but may become necessary late after an ASO, predominantly for neoaortic valve insufficiency and CAPs. Risk at reoperation is not negligible, and DORV TGA-type anatomy, as well as procedures on the coronary arteries, were significantly associated with a higher morbidity and a lower overall survival. Recurrent reoperations after LSRs may be required.

AB - BACKGROUND: We sought to report the frequency, types, and outcomes of left-sided reoperations (LSRs) after an arterial switch operation (ASO) for patients with D-transposition of the great arteries (D-TGA) and double-outlet right ventricle (DORV) TGA-type.METHODS: Seventeen centers belonging to the European Congenital Heart Surgeons Association (ECHSA) contributed to data collection. We included 111 patients who underwent LSRs after 7,951 ASOs (1.4%) between January 1975 and December 2010. Original diagnoses included D-TGA (n = 99) and DORV TGA-type (n = 12). Main indications for LSR were neoaortic valve insufficiency (n = 52 [47%]) and coronary artery problems (CAPs) (n = 21 [19%]).RESULTS: Median age at reoperation was 8.2 years (interquartile range [IQR], 2.9-14 years). Seven patients died early after LSRs (6.3%); 4 patients with D-TGA (5.9%) and 3 patients with DORV TGA-type (25%) (p = 0.02). Median age at last follow-up was 16.1 years (IQR, 9.9-21.8 years). Seventeen patients (16%) required another reoperation, which was more frequent in patients with DORV- TGA type (4 of 9 [45%]) than in patients with D-TGA (13 of 95 [14%]). Late death occurred in 4 patients (4 of 104 [3.8%]). The majority of survivors were asymptomatic at last clinical examination (84 of 100 [84%]).CONCLUSIONS: Reoperations for residual LSRs are infrequent but may become necessary late after an ASO, predominantly for neoaortic valve insufficiency and CAPs. Risk at reoperation is not negligible, and DORV TGA-type anatomy, as well as procedures on the coronary arteries, were significantly associated with a higher morbidity and a lower overall survival. Recurrent reoperations after LSRs may be required.

KW - Adolescent

KW - Aortic Valve Insufficiency

KW - Arterial Switch Operation

KW - Child

KW - Child, Preschool

KW - Double Outlet Right Ventricle

KW - Europe

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Incidence

KW - Infant

KW - Journal Article

KW - Male

KW - Multicenter Study

KW - Postoperative Complications

KW - Prognosis

KW - Reoperation

KW - Retrospective Studies

KW - Risk Factors

KW - Survival Rate

KW - Transposition of Great Vessels

U2 - 10.1016/j.athoracsur.2017.04.026

DO - 10.1016/j.athoracsur.2017.04.026

M3 - Article

C2 - 28709661

SN - 0003-4975

VL - 104

SP - 899

EP - 906

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

IS - 3

ER -

Left-Sided Reoperations After Arterial Switch Operation: A European Multicenter Study

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Keywords

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