Reoperation after arterial switch: A 27-Year experience

Vijayakumar Raju, Harold M. Burkhart, Lucian A. Durham, Benjamin W. Eidem, Sabrina D. Phillips, Zhuo Li, Hartzell V Schaff, Joseph A. Dearani

Research output: Contribution to journalArticle

26 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)2105-2113
Number of pages9
JournalAnnals of Thoracic Surgery
Volume95
Issue number6
DOIs
StatePublished - Jun 2013

Fingerprint

Reoperation
Pathology
Transposition of Great Vessels
Mitral Valve
Pulmonary Artery
Pulmonary Valve
Ventricular Heart Septal Defects
Patient Rights
Aortic Valve
Coronary Artery Bypass
Arterial Switch Operation
Anatomy
Coronary Vessels

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Raju, V., Burkhart, H. M., Durham, L. A., Eidem, B. W., Phillips, S. D., Li, Z., ... Dearani, J. A. (2013). Reoperation after arterial switch: A 27-Year experience. Annals of Thoracic Surgery, 95(6), 2105-2113. https://doi.org/10.1016/j.athoracsur.2013.02.040

Reoperation after arterial switch : A 27-Year experience. / Raju, Vijayakumar; Burkhart, Harold M.; Durham, Lucian A.; Eidem, Benjamin W.; Phillips, Sabrina D.; Li, Zhuo; Schaff, Hartzell V; Dearani, Joseph A.

In: Annals of Thoracic Surgery, Vol. 95, No. 6, 06.2013, p. 2105-2113.

Research output: Contribution to journalArticle

Raju, V, Burkhart, HM, Durham, LA, Eidem, BW, Phillips, SD, Li, Z, Schaff, HV & Dearani, JA 2013, 'Reoperation after arterial switch: A 27-Year experience', Annals of Thoracic Surgery, vol. 95, no. 6, pp. 2105-2113. https://doi.org/10.1016/j.athoracsur.2013.02.040
Raju, Vijayakumar ; Burkhart, Harold M. ; Durham, Lucian A. ; Eidem, Benjamin W. ; Phillips, Sabrina D. ; Li, Zhuo ; Schaff, Hartzell V ; Dearani, Joseph A. / Reoperation after arterial switch : A 27-Year experience. In: Annals of Thoracic Surgery. 2013 ; Vol. 95, No. 6. pp. 2105-2113.
@article{479fbc7c131a4022a8c090802a51da1d,
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.",
author = "Vijayakumar Raju and Burkhart, {Harold M.} and Durham, {Lucian A.} and Eidem, {Benjamin W.} and Phillips, {Sabrina D.} and Zhuo Li and Schaff, {Hartzell V} and Dearani, {Joseph A.}",
year = "2013",
month = "6",
doi = "10.1016/j.athoracsur.2013.02.040",
language = "English (US)",
volume = "95",
pages = "2105--2113",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "6",

}

TY - JOUR

T1 - Reoperation after arterial switch

T2 - A 27-Year experience

AU - Raju, Vijayakumar

AU - Burkhart, Harold M.

AU - Durham, Lucian A.

AU - Eidem, Benjamin W.

AU - Phillips, Sabrina D.

AU - Li, Zhuo

AU - Schaff, Hartzell V

AU - Dearani, Joseph A.

PY - 2013/6

Y1 - 2013/6

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84878237384&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84878237384&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2013.02.040

DO - 10.1016/j.athoracsur.2013.02.040

M3 - Article

C2 - 23618522

AN - SCOPUS:84878237384

VL - 95

SP - 2105

EP - 2113

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 6

ER -