Left-Sided Reoperations After Arterial Switch Operation: A European Multicenter Study

V.L. Vida, L. Zanotto, G. Stellin, M. Padalino, G. Sarris, E. Protopapas, C. Prospero, C. Pizarro, E. Woodford, T. Tlaskal, H. Berggren, M. Kostolny, I. Omeje, B. Asfour, A. Kadner, T. Carrel, P.H. Schoof, M. Nosal, J. Fragata, M. KozłowskiB. Maruszewski, L.A. Vricella, D.E. Cameron, V. Sojak, M. Hazekamp, J. Salminen, I.P. Mattila, J. Cleuziou, P.O. Myers, V. Hraska

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20 Citations (Scopus)


Background We sought to report the frequency, types, and outcomes of left-sided reoperations (LSRs) after an arterial switch operation (ASO) for patients with D-transposition of the great arteries (D-TGA) and double-outlet right ventricle (DORV) TGA-type. Methods Seventeen centers belonging to the European Congenital Heart Surgeons Association (ECHSA) contributed to data collection. We included 111 patients who underwent LSRs after 7,951 ASOs (1.4%) between January 1975 and December 2010. Original diagnoses included D-TGA (n = 99) and DORV TGA-type (n = 12). Main indications for LSR were neoaortic valve insufficiency (n = 52 [47%]) and coronary artery problems (CAPs) (n = 21 [19%]). Results Median age at reoperation was 8.2 years (interquartile range [IQR], 2.9–14 years). Seven patients died early after LSRs (6.3%); 4 patients with D-TGA (5.9%) and 3 patients with DORV TGA-type (25%) (p = 0.02). Median age at last follow-up was 16.1 years (IQR, 9.9–21.8 years). Seventeen patients (16%) required another reoperation, which was more frequent in patients with DORV- TGA type (4 of 9 [45%]) than in patients with D-TGA (13 of 95 [14%]). Late death occurred in 4 patients (4 of 104 [3.8%]). The majority of survivors were asymptomatic at last clinical examination (84 of 100 [84%]). Conclusions Reoperations for residual LSRs are infrequent but may become necessary late after an ASO, predominantly for neoaortic valve insufficiency and CAPs. Risk at reoperation is not negligible, and DORV TGA-type anatomy, as well as procedures on the coronary arteries, were significantly associated with a higher morbidity and a lower overall survival. Recurrent reoperations after LSRs may be required. © 2017 The Society of Thoracic Surgeons
Original languageEnglish
Number of pages8
Publication statusPublished - Sept 2017


  • acute kidney failure
  • adolescent
  • aortic regurgitation
  • aortic stenosis
  • aortic valve stenosis
  • arterial switch operation
  • child
  • clinical examination
  • Conference Paper
  • coronary artery disease
  • Europe
  • female
  • follow up
  • forward heart failure
  • great vessels transposition
  • heart arrhythmia
  • heart left ventricle outflow tract obstruction
  • heart right ventricle double outlet
  • human
  • lung complication
  • lung embolism
  • major clinical study
  • male
  • morbidity
  • multicenter study (topic)
  • neurological complication
  • overall survival
  • postoperative complication
  • postoperative hemorrhage
  • priority journal
  • reoperation
  • retrospective study
  • surgical risk
  • survivor
  • treatment indication
  • vocal cord paralysis
  • adverse effects
  • Aortic Valve Insufficiency
  • clinical trial
  • Double Outlet Right Ventricle
  • incidence
  • infant
  • multicenter study
  • Postoperative Complications
  • preschool child
  • procedures
  • prognosis
  • risk factor
  • survival rate
  • Transposition of Great Vessels
  • trends
  • Adolescent
  • Arterial Switch Operation
  • Child
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Infant
  • Male
  • Prognosis
  • Reoperation
  • Retrospective Studies
  • Risk Factors
  • Survival Rate


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