TRANSPOSITION COMPLEX WITH AORTIC ARCH OBSTRUCTION: OUTCOMES AFTER ONE-STAGE REPAIR IN NEWBORN PERIOD

Abstract

Background. Aortic arch obstruction occurs in 5–9% cases with a combination of TGA and a ventricular septal defect (VSD), and with a double-outlet right ventricle (DORY) with a subpulmonary VSD (Taussig–Bing anomaly), the incidence of aortic arch obstruction is approximately 50%. In the past, surgical tactics with this combination consisted of a double-stage correction; this approach was accompanied by high hospital mortality – 31–64%. With the development of neonatal cardiac surgery, a one-step correction, first described by Pigot, was accepted as the preferred surgical tactic among centers with sufficient experience. This report presents our experience of one-stage arterial switching with aortic arch reconstruction over the last 10 years (2007–2017).Material and Methods. During the period from 2007 to August 2017, we performed 172 arterial switch operations; anomalies of the aortic arch occurred in 12 patients (6.97%), 7 patients with TGA with an ventricular septal defect (VSD), 5 with double outlet of the right ventricle (DORV) with an subpulmonary VSD (Taussig–Bing anomaly). Anomalies of the aortic arch included isolated coarctation of the aorta (n = 2, 17.8%), aortic coarctation with aortic arch hypoplasia (n = 5, 41.6%) and interruption aortic arch (n = 5, 41.6%). The mean age at the time of admission was 2.36 + 1.54 days (1–7 days). The average day in the specialized cardio-resistance unit before the operation was 2.05 + 1.1 days (1–4 days), the average weight was 3.32 + 0.45 kg (2.9–1.1 kg).Results. There were no cases with early and late mortality. In the long-term follow-up period, 5 repeated surgeries (41.6%) were performed in 3 patients. In all cases, the cause was neo-pulmonary artery stenosis, 3 patients underwent balloon angioplasty of the pulmonary artery (18, 24 and 28 months after the initial correction); later, 2 patients required open pulmonary artery plastics (3 and 6 years after endovascular interventions). Residual aortic arch obstruction did not develop in any of the patients, nor did coronary problems and dilatation of the neo-aorta root.Conclusion. In patients with TGA with an ventricular septal defect (VSD), and with a double-outlet right ventricle (DORV) with a subpulmonary VSD (Taussig–Bing anomaly), a one-stage correction in the neonatal period is preferred, which is accompanied by low mortality and morbidity. Features of surgical techniques allow to improve the results of surgical correction. The main problem in the long-term period is the frequent development of stenosis on the neo-pulmonary artery, which requires further improvement of surgical techniques and methods of plasticity of the neo-pulmonary artery.

Keywords

• great arteries transposition
• arterial switch operation
• aortic arch reconstruction