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Skin: Resilience
Published in Philip Berry, Necessary Scars, 2021
Wisheart, one of the Bristol heart surgeons, told the inquiry:‘I believe that the reality of the learning curve may be illustrated by the evolution of surgery for transposition of the Great Arteries in this country … in the late 80s and the very early 90s it was generally understood and accepted that when a unit introduced the Arterial Switch operation for neonates, there would initially be a period of disappointing results.’
Congenital Heart Disease in Pregnancy
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
Due to the late complications of the atrial switch operation, it was eventually developed and first performed successfully in 1975 by Jatene and associates [20]. However, due to early operative complications with coronary ischemia, the arterial switch operation was not performed routinely until the early 1990s. In the arterial switch operation, the aorta and pulmonary artery are transected above the sinuses, and the coronary arteries are disconnected from the native aorta. The great arteries are then re-anastomosed in a “switched” manner, with the aorta now surgically anastomosed to the native pulmonary root (which arises from the left ventricle), and the pulmonary artery now surgically anastomosed anteriorly to the native aortic root (which arises from the right ventricle). The coronary arteries are implanted into the new constructed aortic (“neoaortic”) root. Long-term sequelae of the arterial switch operation include ventricular dysfunction and risk for myocardial ischemia, particularly due to the reimplantation of the coronary arteries. Neoaortic dilation and neoaortic valve regurgitation may also occur.
Methods and Procedures
Published in Richard A. Jonas, Jane W. Newburger, Joseph J. Volpe, John W. Kirklin, Brain Injury and Pediatric Cardiac Surgery, 2019
Jane W. Newburger, Wypij David
The development of the surgical techniques used in the neonatal arterial switch operation during the time that Drs. Castaneda, Jonas, and Mayer were colleagues led to a uniformity of approach that is unusual to find even at a single institution. When our fourth cardiovascular surgeon, Dr. Hanley, joined the staff in 1989, his technique for the arterial switch operation was standardized with that of the other surgeons, and his first three arterial switch operations on study subjects were performed with Dr. Jonas’ assistance.
Aortic Valve Neocuspidization (Ozaki technique) for Pediatric Patients: An Early Single Center Experience
Published in Structural Heart, 2020
David Blitzer, Damien Lapar, Daniel Montana, Anne Ferris, David Solowiejczyk, Lindsay Freud, Thomas Starc, Michael Snyder, Emile Bacha, David Kalfa
Results: There were 11 patients included (male=7). Median age at surgery was 15.8 years (Range 11.0-21.5). Aortic lesions were aortic insufficiency (AI) in 6 patients, aortic stenosis (AS) in 4 and mixed lesions in 1. Three patients had a previous balloon aortic valvuloplasty and one had a prior arterial switch operation for transposition of the great arteries. All three leaflets were replaced in all cases. Glutaraldehyde-treated autologous pericardium or a decellularized bovine pericardial patch was used in 8 and 3 patients respectively. At discharge, one patient had a mild to moderate AI and none had AS. There was no early and late mortality. Median follow-up was 1.1 years (range 0.2-1.4 years). One patient developed a dehiscence of a Photofix© patch 6 weeks after surgery, then underwent a redo AVNeo and has no AI or AS 1.2 years after reoperation. There was no other reoperation. At last follow-up, no patients had AS greater than mild and none had AI greater than mild.
Management of congenitally corrected transposition from fetal diagnosis to adulthood
Published in Expert Review of Cardiovascular Therapy, 2023
All the surgical options mentioned above leave the morphologically RV in the systemic position. A completely new approach to surgical management of ccTGA was proposed at the turn of the 1980s and 1990s [34–36]. The aim of so-called anatomical correction or double-switch procedure is to restore the morphologically left ventricle into the subaortic position. It can be achieved by atrial switch (Mustard/Senning procedure) in combination with arterial switch operation. In patients with pulmonary valve stenosis, the arterial switch procedure cannot be performed. In such cases, the Rastelli procedure, the Nikaidoh procedure and the REV procedure are the options [37]. The long-term survival of anatomic repair is acceptable (20-year survival of 83%) [38], and the long-term complication of the arterial switch is the neoaortic regurgitation [39]. Of importance, this surgical option is available only for infants and young children in whom the morphologically left ventricle is still capable to sustain systemic pressure. In patients without subpulmonary ventricular flow obstruction, the pulmonary artery banding has been proposed as a way to adapt the left ventricle to work as a systemic ventricle. The results of pulmonary artery banding as a bridge to double switch procedure are inconsistent [40–42]. An intention-to-treat analysis of pulmonary artery banding showed that patients above 16 years of age are unlikely to achieve anatomic repair [43]. Some authors noted that individuals with palliative pulmonary artery band had better survival than the anatomic repair group [44], whereas others observed the lowest transplant-free survival at 10 years in this group of patients [45].
Acute kidney injury after arterial switch operation: incidence, risk factors, clinical impact – a retrospective single-center study
Published in Renal Failure, 2023
Anton Puzanov, Vadym Tkachuk, Andriy Maksymenko
There are a few studies describing the incidence of AKI among patients after total repair of TGA – arterial switch operation (ASO). However, the characteristics and complexity of patients included in these studies are heterogeneous. According to this data, AKI develops in 20–50.7% of cases [2–4].