TY - JOUR
T1 - Intervention for Supravalvar Pulmonary Stenosis after the Arterial Switch Operation
AU - Nellis, Joseph R.
AU - Turek, Joseph W.
AU - Aldoss, Osamah T.
AU - Atkins, Dianne L.
AU - Ng, Benton Y.
N1 - Funding Information:
This study reflects the history of a single institution—increasing the likelihood of a geographically select patient population and sampling error. Furthermore, the small sample size (n = 103) limits the power of our study. Additionally, we were unable to collect specific anatomic and perioperative data points (course of the coronaries, intraoperative times, patch material) if they were missing from the patient’s medical record. Lastly, our study focused on the need for and the longevity of reinterventions after the ASO. Our paper reports a peak reintervention rate during the first year after ASO, during which time nearly 70% of patients underwent reintervention if they were going to. Reviewing the dates of the ASO performed in 2013 and the last follow-up data collected in 2014, only 1 patient remained within 1 year of surgery at the time of the data collection. Although largely accounted for, the limited time between the final ASO era and most recent follow-up continues to represent room for reporting bias. This work was funded by the Carver College of Medicine Summer Research Fund.
Publisher Copyright:
© 2016 The Society of Thoracic Surgeons.
PY - 2016/7/1
Y1 - 2016/7/1
N2 - Background. The arterial switch operation is standard of care for infants born with dextrotransposition of the great arteries. Supravalvar pulmonary stenosis is a common complication that may require reintervention - balloon angioplasty, stenting, or surgical augmentation. A subset of patients requires more than one reintervention. Methods. We performed a retrospective review of patients who underwent the arterial switch operation for dextrotransposition of the great arteries at a single institution between August 1990 and January 2014. Anatomic, perioperative and follow-up data were collected. Reinterventions were stratified in a site-specific manner. Statistical analysis was performed using IBM SPSS version 21 (IBM Corp, Armonk, NY). Results. Of the 103 patients who met inclusion criteria, 28% (29) required reintervention for supravalvar pulmonary stenosis; 41% of those receiving primary reintervention required an additional 21 reinterventions. Balloon angioplasty of the main pulmonary artery and left pulmonary artery was associated with the need for multiple reinterventions (odds ratio 4.9, p = 0.051, and odds ratio 5.1, p = 0.029, respectively). Freedom from future reintervention at the main pulmonary artery and left pulmonary artery was significantly shorter after balloon angioplasty relative to alternative reintervention options (hazard ratio 10, p = 0.005, and hazard ratio 3.2, p = 0.02, respectively). Balloon angioplasty of the right pulmonary artery was not associated with an increased risk of reintervention (p = 0.42). Conclusions. Supravalvar pulmonary stenosis after the arterial switch operation for dextrotransposition of the great arteries is common and more than one reintervention are required in a subset of patients. The benefit of balloon angioplasty of the main pulmonary artery and left pulmonary artery was shown to be temporary. Attempting balloon angioplasties at these locations remain reasonable, although families should be counseled about the increased incidence of, and decreased time to, subsequent reintervention that is associated with this treatment option.
AB - Background. The arterial switch operation is standard of care for infants born with dextrotransposition of the great arteries. Supravalvar pulmonary stenosis is a common complication that may require reintervention - balloon angioplasty, stenting, or surgical augmentation. A subset of patients requires more than one reintervention. Methods. We performed a retrospective review of patients who underwent the arterial switch operation for dextrotransposition of the great arteries at a single institution between August 1990 and January 2014. Anatomic, perioperative and follow-up data were collected. Reinterventions were stratified in a site-specific manner. Statistical analysis was performed using IBM SPSS version 21 (IBM Corp, Armonk, NY). Results. Of the 103 patients who met inclusion criteria, 28% (29) required reintervention for supravalvar pulmonary stenosis; 41% of those receiving primary reintervention required an additional 21 reinterventions. Balloon angioplasty of the main pulmonary artery and left pulmonary artery was associated with the need for multiple reinterventions (odds ratio 4.9, p = 0.051, and odds ratio 5.1, p = 0.029, respectively). Freedom from future reintervention at the main pulmonary artery and left pulmonary artery was significantly shorter after balloon angioplasty relative to alternative reintervention options (hazard ratio 10, p = 0.005, and hazard ratio 3.2, p = 0.02, respectively). Balloon angioplasty of the right pulmonary artery was not associated with an increased risk of reintervention (p = 0.42). Conclusions. Supravalvar pulmonary stenosis after the arterial switch operation for dextrotransposition of the great arteries is common and more than one reintervention are required in a subset of patients. The benefit of balloon angioplasty of the main pulmonary artery and left pulmonary artery was shown to be temporary. Attempting balloon angioplasties at these locations remain reasonable, although families should be counseled about the increased incidence of, and decreased time to, subsequent reintervention that is associated with this treatment option.
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U2 - 10.1016/j.athoracsur.2016.01.068
DO - 10.1016/j.athoracsur.2016.01.068
M3 - Article
C2 - 27101727
AN - SCOPUS:84963852443
SN - 0003-4975
VL - 102
SP - 154
EP - 162
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 1
ER -