BACKGROUND: We sought to report the frequency, types, and outcomes of left-sided reoperations (LSRs) after an arterial switch operation (ASO) for patients with D-transposition of the great arteries (D-TGA) and double-outlet right ventricle (DORV) TGA-type. METHODS: Seventeen centers belonging to the European Congenital Heart Surgeons Association (ECHSA) contributed to data collection. We included 111 patients who underwent LSRs after 7,951 ASOs (1.4%) between January 1975 and December 2010. Original diagnoses included D-TGA (n = 99) and DORV TGA-type (n = 12). Main indications for LSR were neoaortic valve insufficiency (n = 52 [47%]) and coronary artery problems (CAPs) (n = 21 [19%]). RESULTS: Median age at reoperation was 8.2 years (interquartile range [IQR], 2.9-14 years). Seven patients died early after LSRs (6.3%); 4 patients with D-TGA (5.9%) and 3 patients with DORV TGA-type (25%) (p = 0.02). Median age at last follow-up was 16.1 years (IQR, 9.9-21.8 years). Seventeen patients (16%) required another reoperation, which was more frequent in patients with DORV- TGA type (4 of 9 [45%]) than in patients with D-TGA (13 of 95 [14%]). Late death occurred in 4 patients (4 of 104 [3.8%]). The majority of survivors were asymptomatic at last clinical examination (84 of 100 [84%]). CONCLUSIONS: Reoperations for residual LSRs are infrequent but may become necessary late after an ASO, predominantly for neoaortic valve insufficiency and CAPs. Risk at reoperation is not negligible, and DORV TGA-type anatomy, as well as procedures on the coronary arteries, were significantly associated with a higher morbidity and a lower overall survival. Recurrent reoperations after LSRs may be required.

Athens Heart Surgery Institute and Department of Pediatric and Congenital Cardiac Surgery Iaso Children's Hospital Athens Greece

Children's Heart Centre University Hospital Motol Prague Czech Republic

Children's Memorial Health Institute Varsavia Poland

Childrens Heart Centre Slovak Republic Bratislava Slovakia

Department for Cardiovascular Surgery University of Bern Bern Switzerland

Department of Cardiothoracic Surgery Hospital de Santa Marta and Nova Medical School Lisbon Portugal

Department of Cardiothoracic Surgery Leiden University Medical Center Leiden Netherlands

Department of Cardiovascular Surgery German Heart Center Munich Technische Universität München Munich Germany

Department of Molecular and Clinical Medicine Children's Heart Center The Queen Silvia's Children's Hospital Göteborg Sweden

Department of Statistical Sciences University of Padua Padua Italy

Division of Cardiac Surgery Johns Hopkins University Baltimore USA

Division of Pediatric Surgery Department of Children and Adolescents Helsinki University Hospital Helsinki Finland

Divison of cardiovascular Surgery Geneva University Hospitals Geneva Switzerland

Great Ormond Street Hospital Cardiothoracic Unit London UK

Herma Heart Center Medical College of Wisconsin Milwaukee WI USA

Herma Heart Center Medical College of Wisconsin Wisconsin USA

Nemours Cardiac Center Alfred 1 duPont Hospital for Children Wilmington Delaware USA

Pediatric and Congenital Cardiac Surgery Unit Department of Cardiac Thoracic and Vascular Sciences University of Padua Padua Italy

University Medical Center Utrecht Utrecht Netherlands

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Long-Term Survival and Freedom From Coronary Artery Reintervention After Arterial Switch Operation for Transposition of the Great Arteries: A Population-Based Nationwide Study