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Intervention for Supravalvar Pulmonary Stenosis After the Arterial Switch Operation.

Publication ,  Journal Article
Nellis, JR; Turek, JW; Aldoss, OT; Atkins, DL; Ng, BY
Published in: Ann Thorac Surg
July 2016

BACKGROUND: The arterial switch operation is standard of care for infants born with dextrotransposition of the great arteries. Supravalvar pulmonary stenosis is a common complication that may require reintervention-balloon angioplasty, stenting, or surgical augmentation. A subset of patients requires more than one reintervention. METHODS: We performed a retrospective review of patients who underwent the arterial switch operation for dextrotransposition of the great arteries at a single institution between August 1990 and January 2014. Anatomic, perioperative and follow-up data were collected. Reinterventions were stratified in a site-specific manner. Statistical analysis was performed using IBM SPSS version 21 (IBM Corp, Armonk, NY). RESULTS: Of the 103 patients who met inclusion criteria, 28% (29) required reintervention for supravalvar pulmonary stenosis; 41% of those receiving primary reintervention required an additional 21 reinterventions. Balloon angioplasty of the main pulmonary artery and left pulmonary artery was associated with the need for multiple reinterventions (odds ratio 4.9, p = 0.051, and odds ratio 5.1, p = 0.029, respectively). Freedom from future reintervention at the main pulmonary artery and left pulmonary artery was significantly shorter after balloon angioplasty relative to alternative reintervention options (hazard ratio 10, p = 0.005, and hazard ratio 3.2, p = 0.02, respectively). Balloon angioplasty of the right pulmonary artery was not associated with an increased risk of reintervention (p = 0.42). CONCLUSIONS: Supravalvar pulmonary stenosis after the arterial switch operation for dextrotransposition of the great arteries is common and more than one reintervention are required in a subset of patients. The benefit of balloon angioplasty of the main pulmonary artery and left pulmonary artery was shown to be temporary. Attempting balloon angioplasties at these locations remain reasonable, although families should be counseled about the increased incidence of, and decreased time to, subsequent reintervention that is associated with this treatment option.

Duke Scholars

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

July 2016

Volume

102

Issue

1

Start / End Page

154 / 162

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Transposition of Great Vessels
  • Stents
  • Retrospective Studies
  • Respiratory System
  • Reoperation
  • Pulmonary Valve Stenosis
  • Pulmonary Artery
  • Postoperative Complications
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Nellis, J. R., Turek, J. W., Aldoss, O. T., Atkins, D. L., & Ng, B. Y. (2016). Intervention for Supravalvar Pulmonary Stenosis After the Arterial Switch Operation. Ann Thorac Surg, 102(1), 154–162. https://doi.org/10.1016/j.athoracsur.2016.01.068
Nellis, Joseph R., Joseph W. Turek, Osamah T. Aldoss, Dianne L. Atkins, and Benton Y. Ng. “Intervention for Supravalvar Pulmonary Stenosis After the Arterial Switch Operation.Ann Thorac Surg 102, no. 1 (July 2016): 154–62. https://doi.org/10.1016/j.athoracsur.2016.01.068.
Nellis JR, Turek JW, Aldoss OT, Atkins DL, Ng BY. Intervention for Supravalvar Pulmonary Stenosis After the Arterial Switch Operation. Ann Thorac Surg. 2016 Jul;102(1):154–62.
Nellis, Joseph R., et al. “Intervention for Supravalvar Pulmonary Stenosis After the Arterial Switch Operation.Ann Thorac Surg, vol. 102, no. 1, July 2016, pp. 154–62. Pubmed, doi:10.1016/j.athoracsur.2016.01.068.
Nellis JR, Turek JW, Aldoss OT, Atkins DL, Ng BY. Intervention for Supravalvar Pulmonary Stenosis After the Arterial Switch Operation. Ann Thorac Surg. 2016 Jul;102(1):154–162.
Journal cover image

Published In

Ann Thorac Surg

DOI

EISSN

1552-6259

Publication Date

July 2016

Volume

102

Issue

1

Start / End Page

154 / 162

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Transposition of Great Vessels
  • Stents
  • Retrospective Studies
  • Respiratory System
  • Reoperation
  • Pulmonary Valve Stenosis
  • Pulmonary Artery
  • Postoperative Complications
  • Male