Back to Search
Start Over
Twenty-Three-Year Experience With the Arterial Switch Operation: Expectations and Long-Term Outcomes
- Source :
- Seminars in Thoracic and Cardiovascular Surgery. 32:292-299
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- We aimed to describe the short- and long-term outcomes of patients after an arterial switch operation (ASO) at a single institution during a 23-year period. A retrospective chart review of all patients18 months of age who underwent an ASO between January 1995 and March 2018 at Texas Children's Hospital, Houston, TX was performed. Primary endpoints include mortality and reintervention. Perioperative mortality was defined as mortality occurring in-hospital and/or30 days after surgery. Survival and freedom-from-reintervention were analyzed using Kaplan-Meier method, log-rank tests, and Cox regression models. The cohort included 394 patients. Diagnoses included 204 patients (52%) with intact ventricular septum, 137 (35%) with a ventricular septal defect, 17 (4%) with a ventricular septal defect and left ventricular outflow tract obstruction (LVOTO), and 36 (9%) with Taussig-Bing anomaly. Median age at surgery was 8 days (range: 1 day to 17 months) and median weight was 3.4 (range: 0.8-12.0) kg. Overall perioperative mortality was 1.3% (n = 5), 0.3% (n = 1) since 1999. Overall survival at 5, 10, and 15 years was 98.2%, 97.8%, and 97.8%, respectively. Perioperative morality was associated with prematurity (P = 0.012),2.5 kg (P0.001), and longer circulatory arrest (P = 0.024) after univariate analysis. Reintervention was associated with a longer cross-clamp time (P0.001),2.5 kg (P = 0.009), LVOTO resection (P = 0.047), and genetic syndrome (P= 0.011) after multivariable analysis. Current ASO expectations should include a perioperative mortality risk of1% and good long-term survival. Reinterventions are more frequent in patients2.5 kg, concomitant LVOTO resection, a genetic syndrome, and longer cross-clamp time.
- Subjects :
- Male
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Time Factors
Transposition of Great Vessels
030204 cardiovascular system & hematology
Balloon atrial septostomy
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Risk Factors
Internal medicine
Chart review
Long term outcomes
Humans
Medicine
Single institution
Retrospective Studies
business.industry
Left ventricular outflow obstruction
Hazard ratio
Infant, Newborn
Infant
General Medicine
Texas
humanities
Confidence interval
Arterial Switch Operation
Treatment Outcome
030228 respiratory system
Retreatment
Cardiology
Deep hypothermic circulatory arrest
Female
Surgery
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 10430679
- Volume :
- 32
- Database :
- OpenAIRE
- Journal :
- Seminars in Thoracic and Cardiovascular Surgery
- Accession number :
- edsair.doi.dedup.....1c181b45dad147984a1416f88ada0d81
- Full Text :
- https://doi.org/10.1053/j.semtcvs.2020.01.004