Impact of different neo-pulmonary artery surgical reconstruction techniques during the arterial switch operation on right ventricular outflow tract obstruction. A multicenter study up to 34-years' follow-up

Background: RVOTO remains the most common complication after ASO in simple TGA. Objectives: To clarify which neo-pulmonary artery reconstruction surgical technique helps to minimize postoperative right ventricular outflow tract obstruction (RVOTO) after the arterial switch operation (ASO) for transposition of the great arteries (TGA). Methods: Patients with isolated d-TGA were identified in the German Registry for Congenital Heart Defects. ASO for isolated d-TGA at an age younger than 10 days between 1986 and 2015 at 16 centers was performed in 106 registered patients. They were divided into two groups (Group 1 - Pantaloon n = 36, Group 2-non Pantaloon n = 70) depending on the neo-pulmonary surgical reconstruction technique used during ASO. Endpoints were RVOTO development, need for reoperation or reintervention for RVOTO, and death. RVOTO was diagnosed echocardiographically. Results: Median follow-up was 9 (4-29) years: the pantaloon group's (group 1) cumulative follow-up was 389 patient-years and 15 (5-34) years, and the non-pantaloon group's (group 2) 1119 patient-years, p = 0.0001. We observed mild RVOTO in 56 % in group 1 and 60 % in group 2 (p-value = 0.53). Group one's moderate RVOTO (3 %) versus 9 % in group 2 (9 %) (p = 0.42). Severe RVOTO was 5 % in group one and 7 % in group two (p = 0.99). There was no difference in freedom from re-operation and survival in both groups. (log-rank p = 0,63, logrank p = 0,25, respectively). Conclusion: Development of mild RVOTO is a common complication in the long-term follow-up after ASO after applying both surgical techniques. We found that both types of neo-pulmonary artery reconstruction techniques were safe in terms of developing severe RVOTO.