Ten Years’ Experience of Arterial Switch Operation for Transposition of the Great Arteries in a Single Moscow City Hospital

Oleg Y. Kornoukhov, Mikhail V. Sokolnikov, Olga A. Ziamina, Valentina N. Tunenko, Vladimir N. Ilyin

Filatov Childrens Hospital, Moscow, Russia

Date, time and location: 2018.05.26 08:30, Press Hall, 2F

Abstract

OBJECTIVES: We reviewed our 10 years’ experience of ASO for TGA to assess the surgical results and late sequelae of this procedure.

METHODS: 128 patients who underwent ASO from 2008 to 2016 were included in this retrospective study. All the procedures were classified as "simple" (n=102) or "complex" (n=26) according to the hospital criteria. Double-staged ASO on clinical grounds was used for 19 patients. The longitudinal data were estimated by the Kaplan–Meier method and compared using a log-rank test. The median follow-up time was 2.8 (0.1–10.0) years.

RESULTS: The hospital survival rates in “simple” and “complex” ASO groups were 95.1% and 84.6% (p=0.048), respectively. There was 1 late death: the patient with complex coronary anatomy died 4,7 months after surgery. All other patients are doing well; 98.3% of them are in NYHA class I. Freedom from aortic regurgitation graded higher than mild was 100%. There was mild dilatation of the neo-aortic valve (Z-score 2.98±1.42) and aortic sinus (Z-score 3.18±1.27). Freedom from supravalvar pulmonary stenosis defined as Doppler-derived peak systolic pressure gradient more than 20 mmHg, and neo-pulmonary regurgitation graded higher than mild was 100%. Freedom from reoperation was 96.6%: two (1.6%) patients underwent coarctation repair at 2.0 and 2.5 months after neonatal primary repair; two other patients underwent surgical repair of external compression of the left main bronchus. Freedom from interventional procedure was 99.2%: one patient underwent balloon angioplasty of the right PA branch.

CONCLUSIONS: The survival and functional outcomes of the ASO were excellent during 10 years of follow-up. Neo-aortic valve dysfunction is rare and mild in our patient’s population. It is necessary to take care a possibility of aortic coarctation and external bronchus compression after neonatal repair. Recognizing and mitigating surgical and ICU errors may lead to reduction in "complex" group operative mortality.