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Complexity stratification of the arterial switch operation: a second learning curve*

Published online by Cambridge University Press:  18 January 2013

Francois Lacour-Gayet
Francois Lacour-Gayet*
Affiliation:
Pediatric Cardiac Surgery, Montefiore Children's Hospital, New York, New York, United States of America
*
Correspondence to: Dr F. Lacour-Gayet, MD, Montefiore Children's Hospital, 3400 Bainbridge Avenue, 5th Floor, New York, New York 10467, United States of America. Tel: +1 718 920 7580; Fax: +1 718 920 7113; E-mail: [email protected]
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Abstract

The arterial switch operation has become a safe operation in many centres. The complexity of the procedure has evolved over the last two decades. Several anatomical features can hardly be considered complex today, namely, normal coronary anatomy, circumflex coming off the right coronary artery, eccentric ostium, and early take-off of an infundibular artery. In addition, as peri-operative mortality becomes very low, the outcomes need to be evaluated on the peri-operative morbidity, late reoperations, and late deaths. The arterial switch operation remains complex in around 20% of the cases, where one or several complexity factors are associated. The complexity of the coronary arteries is a major factor. According to a classification essentially based on the course of the coronary arteries, complex coronaries include: double-looping coronaries, anterior-looping coronaries, intramural coronaries, and single coronary ostium. The most challenging coronary pattern remains the association of a single ostium with intramural course. Other features are equally complex: severe malalignment of the commissures, aortic arch obstruction, multiple ventricular septal defect, Taussig–Bing with subaortic obstruction, double-outlet right ventricle non-committed ventricular septal defect, transposition of the great arteries-intact ventricular septum >3 weeks, transposition of the great arteries-ventricular septal defect with high lung resistances and weight <2.5 kg. Owing to the fact that the risks of arterial switch operation vary according to the experience of the centres, we defined the arterial switch operation complexity based on a subjective approach as proposed by the Aristotle comprehensive score. The recent introduction of a morbidity score will allow to stratify more accurately the outcomes when the peri-operative mortality is very low or nil. The complexity of the coronary patterns tends to be well controlled today. It remains that rare coronary failures and aortic root dilation will occur in the long term, requiring a close follow-up of the most complex patients. Successfully achieving complex arterial switch operation implies a second learning curve.

Type
Original Article
Information
Cardiology in the Young , Volume 22 , Issue 6: A Lifelong Interdisciplinary Approach to Common Arterial Trunk, Transposition of the Great Arteries, and Other Evolving Challenges in Paediatric and Congenital Cardiac Disease , December 2012 , pp. 739 - 744
Copyright
Copyright © Cambridge University Press 2012

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Footnotes

*

Presented at: 12th Annual International Symposium on Congenital Heart Disease, February 17–21, 2012, All Children's Hospital, Saint Petersburg, Florida, United States of America.

References

1. Jatene, AD, Fontes, VF, Paulista, PP, et al. Anatomic correction of transposition of the great vessels. J Thorac Cardiovasc Surg 1976; 72: 364–370.Google Scholar
2. Stoica, S, Carpenter, E, Campbell, D, et al. Morbidity of the arterial switch operation. Ann Thorac Surg 2012; 93: 1977–1983.Google Scholar
3. Fricke, TA, d'Udekem, Y, Richardson, M, et al. Outcomes of the arterial switch operation for transposition of the great arteries: 25 years of experience. Ann Thorac Surg 2012; 94: 139–145.Google Scholar
4. Sarris, GE, Chatzis, AC, Giannopoulos, NM, et al. The arterial switch operation in Europe for transposition of the great arteries: a multi-institutional study from the European Congenital Heart Surgeons Association. J Thorac Cardiovasc Surg 2006; 132: 633–639.Google Scholar
5. Qamar, ZA, Goldberg, CS, Devaney, EJ, Bove, EL, Ohye, RG. Current risk factors and outcomes for the arterial switch operation. Ann Thorac Surg 2007; 84: 871–878.Google Scholar
6. Jacobs, JP, O'Brien, SM, Pasquali, SK, et al. Variation in outcomes for benchmark operations: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Ann Thorac Surg 2011; 92: 2184–2192.Google Scholar
7. O'Brien, SM, Clarke, DR, Jacobs, JP, et al. An empirically based tool for analyzing mortality associated with congenital heart surgery. J Thorac Cardiovasc Surg 2009; 138: 1139–1153.CrossRefGoogle ScholarPubMed
8. Jacobs, ML, O'Brien, SM, Jacobs, JP, et al. An empirically based tool for analyzing morbidity associated with operations for congenital heart disease. J Thorac Cardiovasc Surg 2012, Jul 24 [Epub ahead of print]. PMID: 22835225.Google Scholar
9. Lacour-Gayet, F, Clarke, D, Jacobs, J, et al. The Aristotle score: a complexity-adjusted method to evaluate surgical results. Eur J Cardiothorac Surg 2004; 25: 911–924.Google Scholar
10. Bojan, M, Gerelli, S, Gioanni, S, Pouard, P, Vouhé, P. Comparative study of the Aristotle Comprehensive Complexity and the Risk Adjustment in Congenital Heart Surgery scores. Ann Thorac Surg 2011; 92: 949–956.CrossRefGoogle ScholarPubMed
11. Lacour-Gayet, F, Anderson, RH. A uniform surgical technique for transfer of both simple and complex patterns of the coronary arteries during the arterial switch procedure. Cardiol Young 2005; 15 (Suppl 1): 93–101.Google Scholar
12. Lacour-Gayet, F. Anatomical repair of transposition of the great arteries. In: Gardner TJ, Spray TL (eds). Operative Cardiac Surgery, 5th edn. Arnold, London, 2004, pp 769–791.Google Scholar
13. Asou, T, Karl, TR, Mee, RB, et al. Arterial switch: translocation of intramural coronary arteries. Ann Thorac Surg 1994; 57: 461–465.Google Scholar
14. Scheule, AM, Zurakowski, D, Blume, ED, del Nido, PJ, Mayer, JE, Jonas, RA. Arterial switch with a single coronary arteries. J Thorac Cardiovasc Surg 2002; 123: 1164–1172.CrossRefGoogle Scholar
15. Yacoub, MH, Radley Smith, R. Anatomy of the coronary arteries in transposition of the great arteries and methods of their transfer in anatomical correction. Thorax 1978; 33: 418–425.Google Scholar
16. Planche, C, Lacour-Gayet, F, Kachaner, J, et al. Switch operation for transposition of the great arteries. A study of 120 patients. J Thorac Cardiovasc Surg 1988; 96: 1906–1910.Google Scholar
17. Aubert, J, Pannetier, A, Couvelly, JP, Unal, D, Rouault, F, Delarue, A. Transposition of the great arteries. New technique for anatomical correction. Br Heart J 1978; 40: 204–208.Google Scholar
18. Takeuchi, S, Katogi, K. New technique for the arterial switch operation in difficult situations. Ann Thorac Surg 1990; 50: 1000–1001.Google Scholar
19. Moat, NE, Pawade, A, Lamb, RK. Complex coronary arterial anatomy in transposition of the great arteries: arterial switch procedure without coronary relocation. J Thorac Cardiovasc Surg 1992; 103: 872–876.CrossRefGoogle ScholarPubMed
20. Kim, SJ, Kim, WH, Lim, C, Oh, SS, Kim, YM. Commissural malalignment of aortic-pulmonary sinus in complete transposition of great arteries. Ann Thorac Surg 2003; 76: 1906–1910.Google Scholar
21. Lacour-Gayet, F. Intraventricular repair of double outlet right ventricle. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2008: 39–43.CrossRefGoogle Scholar
22. Artrip, JH, Sauer, H, Lacour-Gayet, F, et al. Biventricular repair of DORV based on the STS-EACTS classification. Eur J Cardiothorac Surg 2006; 29: 545–550.Google Scholar
23. Lacour-Gayet, F, Piot, D, Zoghbi, J, et al. Surgical management and indication of left ventricular retraining in arterial switch for transposition of the great arteries with intact ventricular septum. Eur J Cardiothorac Surg 2001; 20: 824–829.Google Scholar
24. Fan, H, Hu, S, Zheng, Z, et al. Do patients with complete transposition of the great arteries and severe pulmonary hypertension benefit from an arterial switch operation? Ann Thorac Surg 2011; 91: 181–186.Google Scholar
25. Lei, BF, Chen, JM, Cen, JZ, et al. Palliative arterial switch for transposition of the great arteries, ventricular septal defect, and pulmonary vascular obstructive disease: midterm outcomes. J Thorac Cardiovasc Surg 2010; 140: 845–849.Google Scholar
26. Talwar, S, Choudhary, SK, Airan, B. Palliative arterial switch for transposition of the great arteries, ventricular septal defect, and pulmonary vascular obstructive disease (letter). J Thorac Cardiovasc Surg 2011; 141: 848.Google Scholar
27. Curzon, CL, Milford-Beland, S, Li, JS, et al. Cardiac surgery in infants with low birth weight is associated with increased mortality: analysis of the Society of Thoracic Surgeons Congenital Heart Database. J Thorac Cardiovasc Surg 2008; 135: 546–551.CrossRefGoogle Scholar