Outcomes of the arterial switch operation for transposition of the great arteries: 25 years of experience

Tyson Fricke, Yves d'Udekem, Malcolm Richardson, Clarke Thuys, Mithilesh Dronavalli, James Ramsay, Gavin Wheaton, Leeanne Grigg, Christian Brizard, Igor Konstantinov

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    Abstract

    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.

    Original languageEnglish
    Pages (from-to)139-145
    Number of pages7
    JournalAnnals of Thoracic Surgery
    Volume94
    Issue number1
    DOIs
    Publication statusPublished - 2012

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    Fricke, T., d'Udekem, Y., Richardson, M., Thuys, C., Dronavalli, M., Ramsay, J., Wheaton, G., Grigg, L., Brizard, C., & Konstantinov, I. (2012). Outcomes of the arterial switch operation for transposition of the great arteries: 25 years of experience. Annals of Thoracic Surgery, 94(1), 139-145. https://doi.org/10.1016/j.athoracsur.2012.03.019