[III-JCKAP7-2-5] Pulmonary Artery Reintervention After Arterial Switch Operation For Dextro-transposition Of The Great Arteries : A Retrospective Cohort Study
Keywords:D-TGA, Pulmonary stenosis, ASO, Arterial switch operation
Pulmonary stenosis (PS) is a common complication after arterial switch operation (ASO). Many studies report risk factors associated with pulmonary artery (PA) intervention, including small pre-operative PA branches and high PA pressure gradient after ASO. The study determined the outcome of pulmonary stenosis after ASO and its risk factors.
Patients who underwent ASO between 2007 and 2021 were reviewed. All patients with simple d-TGA (TGA/IVS, TGA VSD) were included. The patients with complex anatomy and incomplete medical records were excluded. The patients were divided into two groups and compared concerning PA intervention and non-intervention. Risk factors were analyzed using univariate and multivariate analysis.
Total of 124 patients were included; Nine patients (7%) had PA intervention. After ASO, PA branches become smaller compared to pre-operative echocardiography. The patients with smaller pre-operative PA are associated with higher re-intervention rate [RPA (3.3 ± 1.1 mm, p-value 0.007), LPA (2.9 ± 1 mm, p-value 0.003)]. prolonged operative time [300 minutes (393-423 minutes), p-value 0.01], higher pressure gradient of early post-operative pulmonary stenosis; RPA 62 mmHg (52-84 mmHg, p-value 0.001) and LPA 39 mmHg (21-61 mmHg, p-value 0.02). Coronary artery and VSD are not risk factors for reintervention, according to multivariate analysis.
Pulmonary artery becomes small after the LeCompte maneuver. Pulmonary branch reintervention after ASO may be associated with a smaller pre-operative PA branch, prolonged operative time, and higher pressure gradient after ASO.
Patients who underwent ASO between 2007 and 2021 were reviewed. All patients with simple d-TGA (TGA/IVS, TGA VSD) were included. The patients with complex anatomy and incomplete medical records were excluded. The patients were divided into two groups and compared concerning PA intervention and non-intervention. Risk factors were analyzed using univariate and multivariate analysis.
Total of 124 patients were included; Nine patients (7%) had PA intervention. After ASO, PA branches become smaller compared to pre-operative echocardiography. The patients with smaller pre-operative PA are associated with higher re-intervention rate [RPA (3.3 ± 1.1 mm, p-value 0.007), LPA (2.9 ± 1 mm, p-value 0.003)]. prolonged operative time [300 minutes (393-423 minutes), p-value 0.01], higher pressure gradient of early post-operative pulmonary stenosis; RPA 62 mmHg (52-84 mmHg, p-value 0.001) and LPA 39 mmHg (21-61 mmHg, p-value 0.02). Coronary artery and VSD are not risk factors for reintervention, according to multivariate analysis.
Pulmonary artery becomes small after the LeCompte maneuver. Pulmonary branch reintervention after ASO may be associated with a smaller pre-operative PA branch, prolonged operative time, and higher pressure gradient after ASO.