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The behavior of residual pulmonary artery gradient after arterial switch operation: A longitudinal data analysis
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  • HANI ALKATTAN,
  • Obayda M Diraneyya,
  • Hatem Elmontaser,
  • Joohum Jaweed,
  • Abdulsalam Alsayad,
  • Ahmed Arifi,
  • Abdullah A. Alghamdi
HANI ALKATTAN
National Guard Health Affairs
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Obayda M Diraneyya
National Guard Health Affairs
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Hatem Elmontaser
National Guard Health Affairs
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Joohum Jaweed
National Guard Health Affairs
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Abdulsalam Alsayad
National Guard Health Affairs
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Ahmed Arifi
National Guard Health Affairs
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Abdullah A. Alghamdi
King Abdulaziz Cardiac Center
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Peer review status:ACCEPTED

02 Jul 2020Submitted to Journal of Cardiac Surgery
02 Jul 2020Submission Checks Completed
02 Jul 2020Assigned to Editor
02 Jul 2020Reviewer(s) Assigned
17 Jul 2020Review(s) Completed, Editorial Evaluation Pending
20 Jul 2020Editorial Decision: Revise Minor
23 Jul 20201st Revision Received
27 Jul 2020Submission Checks Completed
27 Jul 2020Assigned to Editor
27 Jul 2020Reviewer(s) Assigned
27 Jul 2020Review(s) Completed, Editorial Evaluation Pending
28 Jul 2020Editorial Decision: Accept

Abstract

Objective: The arterial switch operation is the standard treatment for the transposition of the great arteries. The timely variation in the residual pressure gradient across the pulmonary arteries is ill-defined. This work is aimed to study the progressive changes in the pressure gradient across the pulmonary valve and pulmonary arteries after arterial switch operation (ASO). Methods: All eligible patients for this study who underwent arterial switch operation between 2000 and 2019 were reviewed. Transthoracic echocardiography (TTE), was used to estimate the peak pressure gradient across the pulmonary artery and its branches. The primary outcome was the total peak pressure gradient (TPG) which is the sum of peak pressure gradients across the main pulmonary artery and pulmonary artery branches. Furthermore, a longitudinal data analyses with mixed effect modeling were used to determine the independent predictors for the changes in pressure gradient. Results: 309 patients were included in the study. Over 17-year follow up, the freedom from pulmonary stenosis reintervention was 95% (16 out of the 309 patients underwent reintervention = 5%). the Longitudinal data analyses of serial 1844 echocardiographic studies for the included patients revealed that the TPG recorded in the first postoperative echocardiogram across pulmonary valve, right and left pulmonary artery branches was the most significant predictor for reintervention. Conclusion: The total peak gradient measured in the first postoperative echocardiogram is the most important predictor for reintervention. We propose that a total peak gradient in the first postoperative echocardiography of 55 mmHg or more is a predictor for reintervention