Thorac cardiovasc Surg 2019; 67(01): 037-043
DOI: 10.1055/s-0038-1645877
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Incidence and Risk Factors for Right Ventricular Outflow Tract Obstruction after the Arterial Switch Operation

Julie Cleuziou
1  Department of Cardiovascular Surgery, Deutsches Herzzentrum Munchen des Freistaates Bayern, Munchen, Bayern, Germany
2  Institute for Translational Cardiac Surgery (INSURE), German Heart Centre Munich, Germany
,
Keti Vitanova
1  Department of Cardiovascular Surgery, Deutsches Herzzentrum Munchen des Freistaates Bayern, Munchen, Bayern, Germany
2  Institute for Translational Cardiac Surgery (INSURE), German Heart Centre Munich, Germany
,
Jelena Pabst von Ohain
1  Department of Cardiovascular Surgery, Deutsches Herzzentrum Munchen des Freistaates Bayern, Munchen, Bayern, Germany
2  Institute for Translational Cardiac Surgery (INSURE), German Heart Centre Munich, Germany
,
Masamichi Ono
1  Department of Cardiovascular Surgery, Deutsches Herzzentrum Munchen des Freistaates Bayern, Munchen, Bayern, Germany
2  Institute for Translational Cardiac Surgery (INSURE), German Heart Centre Munich, Germany
,
Daniel Tanase
3  Department of Pediatric Cardiology and Congenital Heart Defects, Deutsches Herzzentrum Munchen des Freistaates Bayern, Munchen, Bayern, Germany
,
Melchior Burri
1  Department of Cardiovascular Surgery, Deutsches Herzzentrum Munchen des Freistaates Bayern, Munchen, Bayern, Germany
2  Institute for Translational Cardiac Surgery (INSURE), German Heart Centre Munich, Germany
,
Rüdiger Lange
1  Department of Cardiovascular Surgery, Deutsches Herzzentrum Munchen des Freistaates Bayern, Munchen, Bayern, Germany
2  Institute for Translational Cardiac Surgery (INSURE), German Heart Centre Munich, Germany
4  Partner site Munich Heart Alliance, Deutsches Zentrum fur Herz-Kreislauf-Forschung eV, Munich, Germany
› Author Affiliations
Further Information

Publication History

22 October 2017

14 March 2018

Publication Date:
01 May 2018 (eFirst)

Abstract

Background The aim of this study was to evaluate the incidence and risk factors for the development of right ventricular outflow tract obstruction (RVOTO) after the arterial switch operation (ASO).

Methods Between 1983 and 2014, a total of 688 patients underwent ASO. RVOTO was defined as any obstruction of the right ventricular outflow tract (RVOT) requiring reintervention.

Results RVOTO developed in 79 patients (11%) at a median time of 3.8 years (range, 1 day–23.6 years) after ASO. Freedom from RVOT reintervention was 96 ± 1, 89 ± 1, and 83 ± 2% at 1, 10, and 25 years, respectively. Independent risk factors for the development of RVOTO in a Cox's regression model were side-by-side great arteries (p < 0.001), aortic arch anomalies (p < 0.001), use of a pericardial patch for augmentation of the coronary buttons (p < 0.001), and a peak gradient more than 20 mm Hg over the RVOT at discharge (p < 0.001).

Conclusion The incidence of RVOTO after ASO is not negligible. Complex morphology, such as side-by-side great arteries and aortic arch anomalies influences the development of RVOTO.