172 - Pulmonary Artery Re-intervention Following The Arterial Switch Operation

Poster Number: 172
Publication Number: 172.101

Samantha L. Miller, University of Louisville School of Medicine, Louisville, KY, United States; Joshua D. Kurtz, University of Louisville School of Medicine, Louisville, KY, United States

Background: Dextro-transposition of the great arteries (D-TGA) is the most prevalent cause of cyanotic congenital heart disease in neonates. The Arterial Switch Operation (ASO) is the preferred surgical procedure used to correct D-TGA. A common complication is narrowing of the branch pulmonary arteries (PAs), which may require a repeat intervention. 

Objective: Our goal is to determine the frequency of patients requiring re-intervention in one or both of the branch pulmonary arteries after the ASO and what factors are associated with re-intervention (RI).

Design/Methods: This is a single center, retrospective study of infants who underwent Arterial Switch Operation at a single center from June 6th, 2011 to February 21st, 2021. The primary outcome was prevalence of re-intervention on the branch pulmonary arteries following the ASO.

Results: Sixty-eight infants were analyzed; 9 (13%) patients had 10 re-interventions. The mean age at time of ASO was 6.52 ± 6.63 days; weight was 3.34 ± 0.57 kg. Those with a RI had a longer bypass time (p = 0.047). Differences in age at ASO, weight at ASO, sex, post-op echo gradients, AA cross clamp time, balloon atrial septostomy, and aortic root dilation were not associated with RI. Mean age at RI was 0.80 ± 0.72 years; mean weight at RI was 7.95 ± 3.98 kg; mean time from ASO was 4.79 ± 3.08 years. 6 surgical procedures, 2 stent placements, and 4 balloon angioplasties were performed on a total of 13 branch PAs. There was no increased risk for RI on the right vs. left PA . After the RI, there was an improvement in the minimal PA diameter (p = 0.018) and echo gradient (p = 0.042). The mean change in minimal diameter was 3.84 ± 3.06 mm; the mean change in gradient was 13.14 ± 12.48 mm Hg. There were no adverse events or mortality related to the re-interventions.Conclusion(s): The prevalence of PA re-intervention following ASO in our cohort was 13%. There is an association between longer circulatory bypass time and PA re-intervention. After re-intervention, there was an increase in PA diameter and a decrease in echo gradient.