Catheter interventions (CI) after arterial switch operation (ASO) for transpostion of the great arteries (TGA) – the importance of major aortopulmonary collaterals (MAPCAs)

  • Frank Riede, Heart Center, University of Leipzig, Germany
  • Martin Kostelka, Heart Center, University of Leipzig, Germany
  • Vit Razek, Heart Center, University of Leipzig, Germany
  • Jörg Hambsch, Heart Center, University of Leipzig, Germany
  • Michael Weidenbach, Heart Center, University of Leipzig, Germany

    • Introduction: Perioperative mortality after ASO has decreased significantly over the last years. However, there is an acceptable but still significant rate of CI and reoperations after ASO.
    Aim of the study: Analysis of type and frequency of CI after ASO with special focus on the role of MAPCAs on which only few data exist.
    Methods: Retrospective single center study. All patients after ASO from 08/1998 to 12/2008 were included.
    Patients: 155 patients underwent ASO from 08/1998 to 12/2008. Median age at operation was 9 days. Median follow up was 219 days (3 days – 10 years). Overall mortality was 0,65%.
    Results: 29 patients (18,8%) underwent CI. Freedom from CI was 81% after 1 year and 64% after 5 and 10 years. Early CI: 11 patients had 12 CI (MAPCAs n=6 (50%), SVC stenosis n=3, coarctation n=2 and LPA stenosis n=1). Late CI: 18 patients underwent 25 CI, during which 28 lesions were treated: supravalvular (n=12) / valvular (n=3) pulmonary stenosis, (re-) coarctation / aortic arch stenosis n=7 and MAPCA n=6 (21%). The indication for early MAPCA closure were severe left ventricular failure, pulmonary hyperperfusion / edema and failure to wean form ventilatory or inotropic support in 4 and radiologic signs of pulmonary hyperfusion in 2 of 6 patients. Patients with late MAPCA closure were asymptomatic.
    Conclusion: Especially in the early postoperative period, timely recognition and treatment of MAPCAs contributes to reduced postoperative morbidity and mortality in patients after ASO.