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30 years’ experience with the arterial switch operation: risk of pulmonary stenosis and its impact on post-operative prognosis

Published online by Cambridge University Press:  30 August 2022

Katarzyna Sobczak-Budlewska Open the ORCID record for Katarzyna Sobczak-Budlewska [Opens in a new window] ,
Monika Łubisz ,
Maciej Moll ,
Tomasz Moszura ,
Jadwiga A. Moll ,
Sara Korabiewska-Pluta ,
Jacek J. Moll  and
Krzysztof W. Michalak Open the ORCID record for Krzysztof W. Michalak [Opens in a new window]
Katarzyna Sobczak-Budlewska*
Affiliation:
Department of Cardiology, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
Monika Łubisz
Affiliation:
Department of Cardiology, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
Maciej Moll
Affiliation:
Department of Cardiac Surgery, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
Tomasz Moszura
Affiliation:
Department of Cardiology, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
Jadwiga A. Moll
Affiliation:
Department of Cardiac Surgery, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
Sara Korabiewska-Pluta
Affiliation:
Department of Cardiology, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
Jacek J. Moll
Affiliation:
Department of Cardiac Surgery, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
Krzysztof W. Michalak
Affiliation:
Department of Didactics in Paediatrics Medical University of Lodz, Lodz, Poland
*
Author for correspondence: Katarzyna Sobczak-Budlewska, Department of Cardiology, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland. Tel: 48607837552. E-mail: katarzyna88sobczak@gmail.com
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Abstract

Pulmonary stenosis is one of the most common complications in patients with transposition of the great arteries after the arterial switch operation. The reason for this is multifactorial and related to the anterior shift of the pulmonary trunk during the LeCompte manoeuvre, the complex suture line required to fill the gaps after harvesting the coronary arteries, and the need for patch implantation to maintain a tensionless anastomosis.

We reviewed all patients with transposition of the great arteries operated on at our institute between 1991 and 2020 to establish the frequency of pulmonary stenosis during post-operative follow-up, reinterventions, and reoperations related to pulmonary stenosis and its potential risk factors.

During the analysed period, we performed 848 arterial switch operations for simple and complex cases of transposition of the great arteries. The overall early mortality was 6.96%, and the late mortality was 2.53%. Among all study groups, 243 (28.66%) patients developed mild pulmonary stenosis, 43 patients (5.07%) developed moderate, and 45 patients (5.31%) developed severe pulmonary stenosis. During follow-up, 21 patients required interventions related to pulmonary stenosis. Pulmonary reconstruction with patches, aortic arch anomalies, and ventricular septal defects associated with transposition of the great arteries were significant risk factors. Nine patients required reoperation because of pulmonary artery stenosis with patch reconstruction of the pulmonary artery, aortic arch anomalies, and aortic cross-clamping time, increasing the risk of reoperation.

Pulmonary stenosis in patients with transposition of the great arteries after the arterial switch operation is a common complication. If significant, it occurs early after surgery and is the most frequent reason for post-operative interventions and reoperations.

Keywords

Arterial switch operationcatheter reinterventionoutcomepulmonary stenosisreoperationtransposition of the great arteries
Type
Original Article
Information
Cardiology in the Young , Volume 33 , Issue 9 , September 2023 , pp. 1550 - 1555
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Copyright
© The Author(s), 2022. Published by Cambridge University Press

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