Paediatrics (RCH) - Theses

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Start date: 2020 × End date: 2022 × Subject: Congenital heart disease × Subject: Arterial switch operation ×

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    Outcomes of the arterial switch operation
    Fricke, Tyson Alexander ( 2020)
    The last few decades have seen great advances in the world of paediatric cardiac surgery. In particular, the arterial switch operation (ASO) is one of the specialty’s most impressive achievements. It is the procedure of choice for most children born with transposition of the great arteries (TGA). This project aimed to expand our understanding of the long-term outcomes and prognosis of patients who have had an ASO for TGA. The ultimate goal of this work was to not only increase clinicians’ knowledge of the long-term consequences of the ASO but also to allow cardiologists, cardiac surgeons and paediatricians to give the parents of patients, and patients themselves, more information about their future cardiac health. We aimed to achieve these goals by retrospectively reviewing patients who underwent an ASO at The Royal Children’s Hospital in Melbourne. This unit has performed the ASO for more than 30 years with a very low hospital mortality from the beginning. This allows for review of a large population of surviving patients from which long-term outcomes can be investigated, and makes possible the analysis of rarer subgroups of patients undergoing the ASO. We showed that the long-term outcomes of patients undergoing the ASO are generally good extending into young adulthood. However, reintervention is common and the incidence of clinically significant neo-aortic regurgitation or the need for neo-aortic root reoperation remains an issue for survivors with more than 25 years of follow-up. In regards to the subgroups examined, we showed that patients with intramural coronaries can be operated with excellent long-term outcomes using a simple, reproducible technique. Children who are less than 2.0 kilograms at time of ASO represent one of the highest mortality risk subgroups. Female adult survivors can undergo pregnancy with a low risk of maternal cardiac complications. Patients with associated aortic arch obstruction have a higher rate of reintervention for right sided obstruction and have a low rate of recurrent arch obstruction when avoiding the use of patch material. We also demonstrated that quality of life in adult ASO survivors was comparable to the general population using a validated quality of life questionnaire.