Analysis of risk factors for mid- and long-term residual after arterial switch operation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LUO Kai , ZHANG Xiaoyang , HE Xiaomin , PAN Yanjun , LIU Xinrong , SHI Guocheng , ZHU Zhongqun , ZHENG Jinghao ,  ZHANG Wei

Department of Pediatric Thoracic and Cardiovascular Surgery, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, P. R. China;

Corresponding?author：

ZHANG Wei, Email: zhangwei@scmc.com.cn

Keywords：

Arterial switch operation; mid- and long-term residual; surgical re-intervention; congenital heart disease

DOI：

10.7507/1007-4848.202310052

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Objective To analyze the risk factors and re-intervention strategies for mid- and long-term residual after arterial switch operation (ASO). Methods The clinical data of children with complex congenital heart disease who underwent ASO surgery in Shanghai Children’s Medical Center from January 2006 to June 2022 were retrospectively collected, and the risk factors for mid- and long-term residual after ASO were analyzed. Results A total of 952 children undergoing ASO were enrolled in this study, including 654 males and 298 females with an average age of (102.9±90.1) d and weight of (4.6±1.6) kg. There were 421 patients with D-transposition of the great arteries with intact ventricular septum (D-TGA/IVS), 357 patients with D-transposition of the great arteries with ventricular septal defect (D-TGA/VSD), and 174 patients with right ventricle double outlet combined with subpulmonary ventricular septal defect (Taussig-Bing malformation). Eighty-nine patients died early after the surgery, the mortality rate was 9.3%. The 746 surviving children were regularly followed up after the surgery (follow-up rate 86.4%), with a median follow-up time of 79.4 (12.0-188.0) months. During the follow-up, 53 children underwent surgical re-intervention due to residual, including 33 males and 20 females, with a median age of 62.5 (17.0-214.0) months. The median surgical weight was 19.0 (8.2-86.0) kg, and the mean time of re-intervention was 28.0-170.0 (77.5±45.4) months after the ASO. Residual problems included common trunk and branch stenosis of the pulmonary artery in 23 patients, right ventricular outflow tract (RVOT) obstruction in 11 patients, left ventricular outflow tract obstruction in 6 patients, aortic arch restenosis in 5 patients, aortic insufficiency in 5 patients, residual shunt of ventricular septal defect in 2 patients, and tricuspid valve insufficiency in 1 patient. The early postoperative mortality rate was 3.8% (2/53), with the causes of death being acute myocardial infarction due to coronary artery injury and acute left heart failure, respectively. The mean follow-up time of the surviving children was (52.4±28.6) months, and no mid- and long-term death occurred. Two patients underwent the third operations due to pulmonary restenosis. The multivariate analysis result showed that combined aortic arch surgery and early postoperative RVOT velocity>3 m/s were independent risk factors for mid- and long-term residual after ASO. Conclusion ASO is an ideal procedure for the treatment of D-TGA/IVS, D-TGA/VSD and Taussig-Bing malformations. Combined aortic arch surgery and early postoperative RVOT velocity>3 m/s are independent risk factors for mid- and long-term residual after ASO.

Citation： LUO Kai, ZHANG Xiaoyang, HE Xiaomin, PAN Yanjun, LIU Xinrong, SHI Guocheng, ZHU Zhongqun, ZHENG Jinghao, ZHANG Wei. Analysis of risk factors for mid- and long-term residual after arterial switch operation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(12): 1696-1701. doi: 10.7507/1007-4848.202310052 Copy

1.	Lo Rito M, Fittipaldi M, Haththotuwa R, et al. Long-term fate of the aortic valve after an arterial switch operation. J Thorac Cardiovasc Surg, 2015, 149(4): 1089-1094.
2.	羅凱, 鄭景浩, 祝忠群, 等. 小兒瓣膜術后殘余瓣膜問題再次干預理念探究. 中華胸心血管外科雜志, 2019, 35(11): 668-674.Luo K, Zheng JH, Zhu ZQ, et al. Clinical research of reintervention for children with postoperative valve disease. Chin J Thorac Cardiovasc Surg, 2019, 35(11): 668-674.
3.	Zhong Y, Bai W, Wang H, et al. Functional tricuspid regurgitation in rheumatic mitral valve disease patients with and without tricuspid annuloplasty: a three-dimensional echocardiography study with one year follow up. Int J Cardiovasc Imaging, 2020, 36(2): 257-268.
4.	王浩, 徐志偉, 王順民, 等. 單中心11年大動脈調轉術早期死亡及遠期再手術分析. 中華胸心血管外科雜志, 2022, 38(10): 577-580.Wang H, Xu ZW, Wang SM, et al. Analysis of early death and long-term reoperation after 11-year single-center arterial switch operation. Chin J Thorac Cardiovasc Surg, 2022, 38(10): 577-580.
5.	Cleuziou J, Vitanova K, Pabst von Ohain J, et al. Incidence and risk factors for right ventricular outflow tract obstruction after the arterial switch operation. Thorac Cardiovasc Surg, 2019, 67(1): 37-43.
6.	Drury NE, Mussa S, Stickley J, et al. Outcomes of the arterial switch for transposition during infancy using a standardized approach over 30 years. Interdiscip Cardiovasc Thorac Surg, 2023, 36(7): ivad070.
7.	Khairy P, Clair M, Fernandes SM, et al. Cardiovascular outcomes after the arterial switch operation for D-transposition of the great arteries. Circulation, 2013, 127(3): 331-339.
8.	Bokenkamp R, Aguilar E, van der Palen RL, et al. Reoperation for right ventricular outflow tract obstruction after arterial switch operation for transposition of the great arteries and aortic arch obstruction. Eur J Cardiothorac Surg, 2016, 49(5): e91-e96.
9.	van der Palen RLF, Blom NA, Kuipers IM, et al. Long-term outcome after the arterial switch operation: 43 years of experience. Eur J Cardiothorac Surg, 2021, 59(5): 968-977.
10.	潘燕軍, 董衛, 王順民, 等. 先天性心臟病手術后繼發性主動脈瓣下狹窄再手術經驗. 中華胸心血管外科雜志, 2017, 33(9): 546-548.Pan YJ, Dong W, Wang SM, et al. Surgical management of secondery subaortic stenosis after repair of congenital heart disease: a ten-year experience. Chin J Thorac Cardiovasc Surg, 2017, 33(9): 546-548.
11.	Luo K, Zheng J, Wang S, et al. Single-stage correction for Taussig-Bing anomaly associated with aortic arch obstruction. Pediatr Cardiol, 2017, 38(8): 1548-1555.
12.	Fricke TA, Thungathurthi K, Naimo PS, et al. Arterial switch operation in patients with Taussig-Bing anomaly and aortic arch obstruction. Ann Thorac Surg, 2022, 114(3): 834-840.
13.	Kobayashi Y, Kotani Y, Kuroko Y, et al. Anatomic risk factors for reintervention after arterial switch operation for Taussig-Bing anomaly. Ann Thorac Surg, 2021, 112(1): 163-169.
14.	Arcieri L, Cantinotti M, Pak V, et al. V-shape reduction plasty to reduce the neoaortic root-ascending aorta discrepancy in children undergoing arterial switch operation. J Card Surg, 2014, 29(3): 410-412.
15.	芮璐, 李守軍, 閆軍, 等. 大動脈調轉術后新主動脈瓣關閉不全10年結果分析. 中國體外循環雜志, 2019, 17(3): 176-179, 192.Rui L, Li SJ, Yan J, et al. New aortic valve regurgitation after arterial switch in D-TGA patients: ten years outcomes from Fuwai Hospital. Chin J Extracorpor Circ, 2019, 17(3): 176-179, 192.

1. Lo Rito M, Fittipaldi M, Haththotuwa R, et al. Long-term fate of the aortic valve after an arterial switch operation. J Thorac Cardiovasc Surg, 2015, 149(4): 1089-1094.
2. 羅凱, 鄭景浩, 祝忠群, 等. 小兒瓣膜術后殘余瓣膜問題再次干預理念探究. 中華胸心血管外科雜志, 2019, 35(11): 668-674.Luo K, Zheng JH, Zhu ZQ, et al. Clinical research of reintervention for children with postoperative valve disease. Chin J Thorac Cardiovasc Surg, 2019, 35(11): 668-674.
3. Zhong Y, Bai W, Wang H, et al. Functional tricuspid regurgitation in rheumatic mitral valve disease patients with and without tricuspid annuloplasty: a three-dimensional echocardiography study with one year follow up. Int J Cardiovasc Imaging, 2020, 36(2): 257-268.
4. 王浩, 徐志偉, 王順民, 等. 單中心11年大動脈調轉術早期死亡及遠期再手術分析. 中華胸心血管外科雜志, 2022, 38(10): 577-580.Wang H, Xu ZW, Wang SM, et al. Analysis of early death and long-term reoperation after 11-year single-center arterial switch operation. Chin J Thorac Cardiovasc Surg, 2022, 38(10): 577-580.
5. Cleuziou J, Vitanova K, Pabst von Ohain J, et al. Incidence and risk factors for right ventricular outflow tract obstruction after the arterial switch operation. Thorac Cardiovasc Surg, 2019, 67(1): 37-43.
6. Drury NE, Mussa S, Stickley J, et al. Outcomes of the arterial switch for transposition during infancy using a standardized approach over 30 years. Interdiscip Cardiovasc Thorac Surg, 2023, 36(7): ivad070.
7. Khairy P, Clair M, Fernandes SM, et al. Cardiovascular outcomes after the arterial switch operation for D-transposition of the great arteries. Circulation, 2013, 127(3): 331-339.
8. Bokenkamp R, Aguilar E, van der Palen RL, et al. Reoperation for right ventricular outflow tract obstruction after arterial switch operation for transposition of the great arteries and aortic arch obstruction. Eur J Cardiothorac Surg, 2016, 49(5): e91-e96.
9. van der Palen RLF, Blom NA, Kuipers IM, et al. Long-term outcome after the arterial switch operation: 43 years of experience. Eur J Cardiothorac Surg, 2021, 59(5): 968-977.
10. 潘燕軍, 董衛, 王順民, 等. 先天性心臟病手術后繼發性主動脈瓣下狹窄再手術經驗. 中華胸心血管外科雜志, 2017, 33(9): 546-548.Pan YJ, Dong W, Wang SM, et al. Surgical management of secondery subaortic stenosis after repair of congenital heart disease: a ten-year experience. Chin J Thorac Cardiovasc Surg, 2017, 33(9): 546-548.
11. Luo K, Zheng J, Wang S, et al. Single-stage correction for Taussig-Bing anomaly associated with aortic arch obstruction. Pediatr Cardiol, 2017, 38(8): 1548-1555.
12. Fricke TA, Thungathurthi K, Naimo PS, et al. Arterial switch operation in patients with Taussig-Bing anomaly and aortic arch obstruction. Ann Thorac Surg, 2022, 114(3): 834-840.
13. Kobayashi Y, Kotani Y, Kuroko Y, et al. Anatomic risk factors for reintervention after arterial switch operation for Taussig-Bing anomaly. Ann Thorac Surg, 2021, 112(1): 163-169.
14. Arcieri L, Cantinotti M, Pak V, et al. V-shape reduction plasty to reduce the neoaortic root-ascending aorta discrepancy in children undergoing arterial switch operation. J Card Surg, 2014, 29(3): 410-412.
15. 芮璐, 李守軍, 閆軍, 等. 大動脈調轉術后新主動脈瓣關閉不全10年結果分析. 中國體外循環雜志, 2019, 17(3): 176-179, 192.Rui L, Li SJ, Yan J, et al. New aortic valve regurgitation after arterial switch in D-TGA patients: ten years outcomes from Fuwai Hospital. Chin J Extracorpor Circ, 2019, 17(3): 176-179, 192.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Analysis of risk factors for mid- and long-term residual after arterial switch operation

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