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Salve GG, Betts KS, Ayer JG, et al. A Simplified Approach to Predicting Reintervention in the Arterial Switch Operation. Semin Thorac Cardiovasc Surg. 2021;doi: 10.1053/j.semtcvs.2021.04.058.
Salve, G. G., Betts, K. S., Ayer, J. G., Chard, R. B., Nicholson, I. A., Orr, Y., & Winlaw, D. S. (2021). A Simplified Approach to Predicting Reintervention in the Arterial Switch Operation. Seminars in thoracic and cardiovascular surgery, . https://doi.org/10.1053/j.semtcvs.2021.04.058
Salve, Gananjay G, et al. "A Simplified Approach to Predicting Reintervention in the Arterial Switch Operation." Seminars in thoracic and cardiovascular surgery vol. (2021). doi: https://doi.org/10.1053/j.semtcvs.2021.04.058
Salve GG, Betts KS, Ayer JG, Chard RB, Nicholson IA, Orr Y, Winlaw DS. A Simplified Approach to Predicting Reintervention in the Arterial Switch Operation. Semin Thorac Cardiovasc Surg. 2021 Sep 09; doi: 10.1053/j.semtcvs.2021.04.058. Epub 2021 Sep 09. PMID: 34508814.
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Semin Thorac Cardiovasc Surg. 2021 Sep 09; doi: 10.1053/j.semtcvs.2021.04.058. Epub 2021 Sep 09.

A Simplified Approach to Predicting Reintervention in the Arterial Switch Operation.

Seminars in thoracic and cardiovascular surgery

Gananjay G Salve, Kim S Betts, Julian G Ayer, Richard B Chard, Ian A Nicholson, Yishay Orr, David S Winlaw

Affiliations

  1. Heart Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
  2. School of Public Health, Curtin University, Perth, Australia.
  3. Heart Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; School of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
  4. Heart Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia; School of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia. Electronic address: [email protected].

PMID: 34508814 DOI: 10.1053/j.semtcvs.2021.04.058

Abstract

We investigated patients with transposition anatomy suitable for the arterial switch operation (ASO) to evaluate a simplified approach to prediction of reintervention. A retrospective review was performed of 180 consecutive patients who underwent ASO from 2009 to 2018. Patients were classified as Category I (n = 122) d-transposition of great arteries (dTGA) + intact ventricular septum, Category II (n = 28) dTGA + ventricular septal defect (VSD) and Category III (n = 30) dTGA + Aortic arch obstruction (AAO) +/- VSD or Taussig-Bing Anomaly (TBA) +/- AAO. Outcomes included reintervention-free survival (using Kaplan-Meier estimates) and predictors of reintervention. Median follow up was 3.3 (interquartile range 1.7-5.8) years with no difference between categories(P = 0.082). There were 3 mortalities- 2 early (one each in Category I and II) and one late (in Category I). Reintervention-free survival for the whole group at 1, 3, 5 and 8 years was 94%, 91%, 90% and 86% respectively. Conventional criteria predicting reintervention included the presence of TBA(P = 0.0054) and AAO(P = 0.027). Low birth weight did not predict reintervention(P = 0.2). When analyzed by category, multivariable analysis showed that patients in Category III carried a high risk of reintervention [Hazard risk (HR) = 7.43, 95% confidence interval (CI)=(2.39, 23.11), P < 0.001], but so did those in Category II [HR=6.90, 95% CI = (2.19, 21.75, P < 0.001] when compared to Category I. Conventional risk factors for technical difficulty may not be the best predictors of reintervention. A simplified approach highlights Category II patients (dTGA + VSD) as being at substantial risk of re-intervention, and not part of a low risk cohort.

Copyright © 2021. Published by Elsevier Inc.

Keywords: Aortic arch obstruction; Arterial switch operation; Intact ventricular septum; Taussig-Bing anomaly; Transposition of the great arteries; Ventricular septal defect

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