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Ann Thorac Surg 2002;73:88-95
© 2002 The Society of Thoracic Surgeons
a Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
* Address reprint requests to Dr Gandhi, Division of Pediatric Cardiothoracic Surgery, Children’s Hospital of Pittsburgh, Suite 2820, 3705 Fifth Ave, Pittsburgh, PA 15213-2583, USA
e-mail: gandhis{at}heart.chp.edu
Presented at the Thirty-seventh Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 29–31, 2001.
Background. The arterial switch operation is the therapy of choice for transposition of the great arteries.
Methods. A retrospective analysis of all children undergoing the arterial swtich operation between November 1985 and October 2000 was conducted, highlighting the frequency and nature of late invasive reintervention.
Results. One hundred forty-four children were operated on. Operative survival was 89% (128 of 144). Late reintervention was required in 23% (29 of 128) of survivors. Neopulmonary stenosis (PS) was the most common complication requiring treatment, occurring in 16% (21 of 128) of patients. Eleven of 21 patients with PS required reoperation, whereas 10 were managed with percutaneous techniques. Other indications for reintervention included aortic arch obstruction (3 patients), ventricular septal defect (with PS in 2 patients), bronchial stenosis (2 patients), coronary stenosis (2 patients), aortic stenosis (with PS in 1 patient), and residual atrial septal defect (1 patient). There has been no mortality or major morbidity in those children who have undergone reintervention.
Conclusions. Invasive reintervention after the arterial switch operation is occasionally required. The most common indication is PS. Reintervention is well tolerated by those children who require it. Continued follow-up for late complications is required in this patient population.
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