Document Type : original article

Authors

• Avisa Tabib ¹
• Mahmoud Meraji ²
• Mohammad Mahdavi ²
• Mohammad Rafie Khorgami ²
• Golnar Mortaz Hejri ²
• Sepideh Banar ¹
• Golnaz Hajiesmail ²

¹ Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

² Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

Abstract

Study Design: Retrospective cohort study

Background: The arterial switch operation (ASO) has been the preferred surgical method for TGA since its introduction over 40 years ago. Although initial survival rates have improved significantly, long-term complications often require reoperation.

Methods: 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 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 transposition of the great arteries (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.

Keywords

• transposition of great arteries
• arterial switch operation
• reoperation
• pediatric heart disease