Document Type : original article

Authors

1 MD, Associate Professor of Pediatric Cardiology, Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

2 MD, Professor of Pediatric Cardiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

3 MD, Associate Professor of Pediatric Cardiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

4 MD, Research Fellow, Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

5 MD, Pediatric Cardiologist, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

10.22038/jpp.2024.83778.5498

Abstract

Background: The Arterial Switch Operation (ASO) has been the preferred surgical method for Transposition of great arteries (TGA) since its introduction over 40 years ago. Although initial survival rates have improved significantly, long-term complications often require reoperation.
Methods: In this retrospective cohort study, medical records of 302 patients with TGA, who underwent ASO between 2004 and 2022, were reviewed. Data on demographic and morphological characteristics, surgical reports, and follow-up interventions were collected. Reoperation data, including surgical and catheter-based interventions, were analyzed.
Results: Thirty-seven reoperations were performed on 31 patients, with a reoperation rate of 10.26%. Open surgical interventions included Right Ventricle Outflow Tract Obstruction (RVOTO) relief (3.31%), neo-aortic root and valve surgery (0.66%), ascending aorta replacement (0.33%), VSD closure (0.33%), and pacemaker implantation (2.31%). Catheter-based interventions included balloon angioplasty (1.65%) and stent implantation (1.65%) for RVOTO, with additional procedures for aortic arch stenosis (0.66%) and coronary artery stenosis (0.33%). Residual shunts were treated in 0.99% of cases.
Conclusion: ASO has revolutionized the management of TGA, providing infants a chance at a normal, healthy life. As our understanding of congenital heart defects grows, ASO remains pivotal in enhancing patient outcomes. Despite the average time to reoperation being 4 years, regular follow-up is essential. Gradual complication development necessitates periodic monitoring to prevent escalation requiring surgical intervention.

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