Mid-term morbidity and mortality of patients after arterial switch operation in infancy for transposition of the great arteries.

INTRODUCTION AND OBJECTIVES: The arterial switch operation is currently the preferred surgical approach for complete transposition of the great arteries. We sought to determine the mid-term results of this intervention. METHODS: A single-institution retrospective review of clinical records of all consecutive patients who underwent the arterial switch surgery between 1985 and 2010. RESULTS: Overall, the operation was performed on 155 patients (68% boys) at a median age of 13 days: 64% with an intact septum, 46% with a ventricular septal defect, and 4.5% with associated aortic arch anomaly. The usual coronary pattern was found in 63%. Palliative surgery was performed prior to arterial switch in 6.5%. In all, 137 perioperative survivors were followed for a median of 6 years. Late mortality was 2.9%, of which 50% was due to coronary complications. Eighteen percent required surgical and/or percutaneous reintervention: 95.6% for right-sided obstruction and 4.3% for aortic regurgitation. At last follow-up, 92% had functional class I symptoms and 95% were free of arrhythmias. The left ventricular ejection fraction was greater than 55% in 95%, 28% had neoaortic regurgitation (78% mild regurgitation), and 31% had right ventricular outflow tract obstruction with a mean gradient according to echocardiography greater than 25mmHg. CONCLUSIONS: Mid-term survival of patients after arterial switch operation is excellent and their functional status is good. However, a few patients have residual lesions and a need for further intervention during follow-up, mostly for right-sided obstructions. Late mortality was uncommon and was related to coronary complications. Neoaortic root dilation and regurgitation are not major issues in early adulthood, but the long-term course of these lesions is still unknown.

Quo vadis, litoplastia coronaria / Quo vadis, coronary lithoplasty

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Cierre percutáneo de fugas paravalvulares residuales después del cierre percutáneo de la orejuela izquierda con dispositivo WATCHMAN: serie de dos casos / Catheter-based closure of residual leaks after percutaneous occlusion of the left atrial appendage with WATCHMAN device: two cases

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Morbilidad y mortalidad de los pacientes con transposición completa de grandes arterias intervenidos mediante cirugía de corrección arterial / Mid-term Morbidity and Mortality of Patients After Arterial Switch Operation in Infancy for Transposition of the Great Arteries

Introducción y objetivos: La corrección anatómica es el tratamiento de elección para neonatos con transposición de grandes arterias. El objetivo es analizar resultados a medio plazo de esta intervención. Métodos: Estudio retrospectivo de los registros clínicos de todos los pacientes consecutivos operados mediante cirugía de intercambio arterial en el hospital infantil desde 1985 hasta 2010. Resultados: Se intervino a 155 pacientes (el 68% varones) a una mediana de edad de 13 días: el 64% con transposición completa con septo íntegro; el 46% con comunicación interventricular, y el 4,5% con enfermedad del arco aórtico asociada. El patrón coronario fue el usual en el 63%. Se realizó cirugía previa al 6,5%. De 137 supervivientes seguidos durante una mediana de 6 años, la mortalidad tardía fue del 2,9%, el 50% debido a complicaciones coronarias. El 18% requirió reintervención quirúrgica y/o angioplastia: el 95,6% por estenosis en el tronco y/o las ramas pulmonares y el 4,3% por insuficiencia aórtica. En la última revisión estaban en clase funcional I (92%) y sin arritmias (95%). La fracción de eyección del ventrículo izquierdo fue mayor del 55% en el 95%, el 28% tenía insuficiencia aórtica (el 78% de grado I) y el 31%, estenosis a la salida del ventrículo derecho (gradiente medio superior a 25 mmHg). Conclusiones: Los pacientes con corrección anatómica presentan buena supervivencia y buen estado funcional a medio plazo; las lesiones residuales del tronco o la arteria pulmonar son la complicación más frecuente y causa de reintervención. La muerte tardía de causa cardiaca no es un suceso frecuente, pero parece relacionado con complicaciones coronarias. Aunque hay casos de insuficiencia aórtica precoz, aún desconocemos la evolución a largo plazo en la vida adulta de la dilatación de la neorraíz de aorta e insuficiencia aórtica (AU)

Introduction and objectives: The arterial switch operation is currently the preferred surgical approach for complete transposition of the great arteries. We sought to determine the mid-term results of this intervention. Methods: A single-institution retrospective review of clinical records of all consecutive patients who underwent the arterial switch surgery between 1985 and 2010. Results: Overall, the operation was performed on 155 patients (68% boys) at a median age of 13 days: 64% with an intact septum, 46% with a ventricular septal defect, and 4.5% with associated aortic arch anomaly. The usual coronary pattern was found in 63%. Palliative surgery was performed prior to arterial switch in 6.5%. In all, 137 perioperative survivors were followed for a median of 6 years. Late mortality was 2.9%, of which 50% was due to coronary complications. Eighteen percent required surgical and/or percutaneous reintervention: 95.6% for right-sided obstruction and 4.3% for aortic regurgitation. At last follow-up, 92% had functional class I symptoms and 95% were free of arrhythmias. The left ventricular ejection fraction was greater than 55% in 95%, 28% had neoaortic regurgitation (78% mild regurgitation), and 31% had right ventricular outflow tract obstruction with a mean gradient according to echocardiography greater than 25 mmHg. Conclusions: Mid-term survival of patients after arterial switch operation is excellent and their functional status is good. However, a few patients have residual lesions and a need for further intervention during follow-up, mostly for right-sided obstructions. Late mortality was uncommon and was related to coronary complications. Neoaortic root dilation and regurgitation are not major issues in early adulthood, but the long-term course of these lesions is still unknown (AU)