title: Arterial switch operation for simple and complex TGA--indication criterias and limitations relevant to surgery.
abstract: Since 1983, 505 patients underwent the arterial switch operation (ASO). 326 (28 days) had transposition of the great arteries with an intact ventricular septum (TGA/IVS) und 179 had a ventricular septal defect (TGA/VSD). Mean age at ASO was 7 +/- 5 days. Total mortality in the neonatal group was 7%. In the last 150 neonates, there was no operative mortality. Two late deaths were due to coronary obstruction 6 and 7 weeks after ASO. Cardiac catherisation in 106 late survivors revealed a mean gradient form RV to PA of 20 +/- 20 mmHg, and from LV to aorta of 5 +/- 8 mmHg. Mean PA pressure was 13 +/- 4 mmHg; enddiastolic pressure in the left ventricle was 8 +/- 3 mmHg. Cardiac index was 4.0 +/- 1.2 L/min. Sinus node recovery time was normal in 97%. Asymptomatic occlusion of a coronary artery was present in 3 patients. Aortic regurgitation was moderate in 1%. Rapid two-stage ASO (preliminary PA banding and shunt followed by ASO after 7 days) was carried out successfully in 29/30 patients with TGA/IVS, the oldest being 28 months of age. The ASO, as a primary operation, is our treatment of choice for neonates with TGA/IVS and TGA/VSD. The rapid two-stage approach is applicable for older patients with TGA/IVS.
authors.affiliation: Department of Cardiac Surgery, Children's Hospital, Boston.
authors.forename: A
authors.initials: A
authors.lastname: Castaneda
mesh_terms: D006328:Cardiac Catheterization; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000601:surgery; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*