Incidence of Reoperation in Patients with History of Arterial Switch Operation: A Single Institution Eighteen Years Retrospective Cohort Study

Abstract Study Design: Retrospective cohort study Background: The arterial switch operation (ASO) has been the preferred surgical method for TGA since its introduction over 40 years ago. Although initial survival rates have improved significantly, long-term complications often require reoperation. Methods: Medical records of 302 patients with TGA who underwent ASO between 2004 and 2022 were reviewed. Data on demographic and morphological characteristics, surgical reports, and follow-up interventions were collected. Reoperation data, including surgical and catheter-based interventions, were analyzed. Results: Thirty-seven reoperations were performed on 31 patients, with a reoperation rate of 10.26%. Open surgical interventions included RVOTO relief (3.31%), neo-aortic root and valve surgery (0.66%), ascending aorta replacement (0.33%), VSD closure (0.33%), and pacemaker implantation (2.31%). Catheter-based interventions included balloon angioplasty (1.65%) and stent implantation (1.65%) for RVOTO, with additional procedures for aortic arch stenosis (0.66%) and coronary artery stenosis (0.33%). Residual shunts were treated in 0.99% of cases. Conclusion: ASO significantly improves the prognosis for patients with TGA, though a notable proportion require reoperation due to complications such as RVOTO, neo-aortic valve dysfunction, and residual shunts. This study underscores the need for regular, long-term follow-up to promptly identify and manage post-operative complications.