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Arterial Switch for TGA or DORV and VSD, with and Without Aortic Arch Obstruction

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Surgery of Conotruncal Anomalies

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Abstract

Arterial switch operations undertaken in transposition of the great arteries (TGA) and Taussig Bing with ventricular septal defect (VSD) are complex. The association with an aortic arch obstruction (AAO), seen predominantly in Taussig-Bing increased significantly the complexity of the operation. One-stage neonatal repair has become the technique of reference. However, palliation remains indicated in newborns presenting with Swiss cheese VSDs, small birth weight and extra cardiac damages.

The increasing difficulties of the arterial switch operation in TGA/DORV-VSD are: the important diameter mismatch between the aorta and the pulmonary root, − the closure of the VSD, − the management of more complex coronary artery patterns, the association with AAO and the presence of a subaortic obstruction.

The ASO mortality, reported by the STS database congenital database is respectively 5 % for TGA/DORV-VSD without AAO and 12.6 % when an AAO is associated.

Late reoperations occur in 30 %, either: re-coarctation, right ventricular obstruction, aortic valve regurgitation, aortic root dilation and coronary stenosis. Long-term actuarial survival is 85 % at 15 years; nevertheless, close lifelong surveillance of these patients is necessary.

Complex arterial switch remain challenging and require a second learning curve.

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Authors and Affiliations

  1. Department of Pediatric Cardiac Surgery, National Heart and Lung Institute, Royal Brompton Hospital, Imperial College University, Sydney Street, London, SW3 6NP, UK

    Francois Lacour-Gayet MD

  2. Department of Pediatric Cardiac Surgery, Hôpital Jacques Cartier, Massy, 92000, France

    Emre Belli MD

  3. Department of Pediatric Cardiac Surgery, Royal Brompton Hospital, Sydney Street, London, SW3 6NP, UK

    Olivier Ghez MD

Authors
  1. Francois Lacour-Gayet MD
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  2. Emre Belli MD
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  3. Olivier Ghez MD
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Corresponding author

Correspondence to Francois Lacour-Gayet MD .

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Editors and Affiliations

  1. Royal Brompton Hospital, London, United Kingdom

    Francois Lacour-Gayet

  2. C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan, USA

    Edward L. Bove

  3. German Pediatric Heart Center, Asklepios Klinik Sankt Augustin Gmb, Sankt Augustin, Germany

    Viktor Hraška

  4. University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, USA

    Victor O. Morell

  5. Department of Cardiothoracic Surgery, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

    Thomas L. Spray

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Lacour-Gayet, F., Belli, E., Ghez, O. (2016). Arterial Switch for TGA or DORV and VSD, with and Without Aortic Arch Obstruction. In: Lacour-Gayet, F., Bove, E., Hraška, V., Morell, V., Spray, T. (eds) Surgery of Conotruncal Anomalies. Springer, Cham. https://doi.org/10.1007/978-3-319-23057-3_15

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  • DOI: https://doi.org/10.1007/978-3-319-23057-3_15

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-23056-6

  • Online ISBN: 978-3-319-23057-3

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