Long-term outcomes of the arterial switch operation

J Thorac Cardiovasc Surg. 2022 Jan;163(1):212-219. doi: 10.1016/j.jtcvs.2021.01.134. Epub 2021 Feb 11.

Abstract

Objectives: The arterial switch operation (ASO) has excellent early outcomes in the modern era. We sought to determine the long-term outcomes in patients who underwent an ASO at a single institution.

Methods: Patients who underwent an ASO between 1983 and 2015 were identified from the hospital database and retrospectively reviewed using hospital records.

Results: From 1983 to 2015, 844 patients with a biventricular circulation underwent an ASO. There were 28 (3.3%, 28/844) early deaths. Follow-up was available for 94% (729/774) of local patients after hospital discharge. Median follow-up was 15 years (interquartile range, 8-20 years). There were 187 (26%, 187/729) patients with more than 20 years of follow-up and 95 (13%, 95/729) patients with more than 25 years of follow-up. Overall survival was 95% (95% confidence interval [CI], 94%-97%) at 10 and 25 years after the ASO. At 25 years after ASO, freedom from overall reintervention was 77% (95% CI, 73%-81%), freedom from reoperation on the neoaortic root or neoaortic valve was 92% (95% CI, 88%-95%), and freedom from coronary reoperation was 99% (95% CI, 98%-99.7%). Left ventricular (LV) systolic function was normal in 595 of 609 (98%) of patients who had LV function quantified at latest follow-up. Of the 95 patients with more than 25 years of follow-up after ASO, 6 (6.3%) had at least moderate neoaortic valve regurgitation (AR) and 8 (8.4%) had undergone replacement of the neoaortic valve.

Conclusions: Overall, survivors of ASO have excellent late survival and normal LV systolic function into adult life. However, AR and reoperation on the neoaortic valve remains an issue for older patients.

Keywords: arterial switch operation; transposition of the great arteries.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aortic Valve Insufficiency* / diagnosis
  • Aortic Valve Insufficiency* / epidemiology
  • Aortic Valve Insufficiency* / etiology
  • Aortic Valve Insufficiency* / surgery
  • Aortic Valve* / pathology
  • Aortic Valve* / surgery
  • Arterial Switch Operation* / adverse effects
  • Arterial Switch Operation* / methods
  • Arterial Switch Operation* / statistics & numerical data
  • Australia / epidemiology
  • Female
  • Follow-Up Studies
  • Heart Septal Defects, Ventricular / epidemiology
  • Heart Septal Defects, Ventricular / surgery
  • Humans
  • Infant, Newborn
  • Long Term Adverse Effects* / diagnosis
  • Long Term Adverse Effects* / physiopathology
  • Long Term Adverse Effects* / surgery
  • Male
  • Outcome Assessment, Health Care / statistics & numerical data
  • Postoperative Complications* / diagnosis
  • Postoperative Complications* / mortality
  • Postoperative Complications* / physiopathology
  • Postoperative Complications* / surgery
  • Reoperation* / methods
  • Reoperation* / statistics & numerical data
  • Retrospective Studies
  • Transposition of Great Vessels* / epidemiology
  • Transposition of Great Vessels* / physiopathology
  • Transposition of Great Vessels* / surgery
  • Ventricular Function, Left