Outcomes of the Arterial Switch Operation for Transposition of the Great Arteries: 25 Years of Experience

• Published in: The Annals of thoracic surgery Vol. 94; no. 1; pp. 139 - 145
• Main Authors: Fricke, Tyson A., BMedSc, d'Udekem, Yves, MD, PhD, Richardson, Malcolm, MBBS, Thuys, Clarke, BAppSc, Dronavalli, Mithilesh, MBBS, BMedSc, Ramsay, James M., MBBS, Wheaton, Gavin, MBBS, Grigg, Leeanne E., MBBS, Brizard, Christian P., MD, Konstantinov, Igor E., MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2012; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiology. Vascular system; Cardiothoracic Surgery; Child; Child, Preschool; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Extracorporeal Membrane Oxygenation; Follow-Up Studies; Heart; Humans; Infant; Infant, Newborn; Medical sciences; Multivariate Analysis; Pneumology; Postoperative Complications - epidemiology; Surgery; Transposition of Great Vessels - mortality; Transposition of Great Vessels - surgery; Treatment Outcome; Ventricular Outflow Obstruction - surgery; PS; coarctation of aorta; IVS; left ventricular outflow tract obstruction; COA; pulmonary stenosis; LVOTO; arterial switch operation; cardiopulmonary bypass; extracorporeal membrane oxygenation; intact ventricular septum; transposition of great arteries; ventricular septal defect; ASO; hypoplastic aortic arch; CA; ECMO; right ventricular outflow tract obstruction; aortic cross-clamp; VSD; IAA; HAA; RVOTO; interrupted aortic arch; AAO; TGA; CPB; Circulatory arrest; aortic arch obstruction; AXCL; 21; Prognosis; Cardiovascular disease; Operation; Congenital disease; Vascular disease; Experience; Treatment; Heart disease; Surgery; Anesthesia; Circulatory system; Transposition of the great vessels; Cardiology
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2012.03.019

Background Studies on long-term outcomes of the arterial switch operation (ASO) for transposition of the great arteries (TGA) are uncommon. Thus, we sought to determine the long-term outcomes for patients after ASO performed at a single institution over a 25-year period. Methods From 1983 to 2009, 618 patients underwent the ASO for TGA and were reviewed retrospectively. Results Overall early mortality was 2.8%. Risk factors for early death on multivariate analysis were resection of left ventricular outflow tract obstruction at time of ASO ( p = 0.001), weight less than 2.5 kg at time of ASO ( p < 0.001), associated aortic arch obstruction ( p = 0.043), and the need for postoperative extracorporeal membrane oxygenation ( p < 0.001). Mean follow-up time was 10.6 years (range 2 months to 26.1 years). Late mortality was 0.9%. Reintervention was significantly higher ( p < 0.001) in patients with ventricular septal defect or arch obstruction versus those without them (25.2% and 23.4% vs 5.9% at 15- year follow-up). Risk factors for late reintervention were left ventricular outflow tract obstruction at time of ASO ( p < 0.001) and a greater circulatory arrest time ( p < 0.001). Freedom from at least moderate neoaortic valve regurgitation for the entire cohort was 98.7% (95% confidence interval 96.8 to 99.5%) at 20 years. Mild neoaortic regurgitation was seen in 25.6% of patients at mean follow-up. All patients were free of arrhythmia and heart failure symptoms at last follow-up. Conclusions The ASO can be performed with good long-term results. Patients with associated ventricular septal defect and aortic arch obstruction warrant close follow-up.