Intermediate results from the period of the Congenital Heart Surgeons Transposition Study: 1985 to 1989. Congenital Heart Surgeons Society Database.
BACKGROUND
The period of the Congenital Heart Surgeons Society (CHSS) study (1985 to 1989) provided a transition in the treatment of d-transposition of the great arteries. During this unusual time frame neonatal arterial switch (AS) and neonatal or late atrial baffle repair (Senning) were used in near equal proportion at one reporting institution. All the procedures were performed at this single institution, avoiding the variability intrinsic to a multicenter study. Intermediate follow-up of the results is presented.


METHODS
During the period of the CHSS study, January 1985 to March 1989, 46 patients were enrolled in the CHSS study at one institution. Forty-four underwent either neonatal arterial (n = 14, 32%) or neonatal atrial (n = 19, 43%) or late atrial (n = 11, 25%) repair of d-transposition of the great arteries. Ages ranged from 4 to 80 days. Overall survival for the entire series was 91% (40/44). The survival of the AS group operate on in the neonatal period was 93% (13/14). The survival of the Senning group was 90% (27/30); late Sennings, 91% (10/11); and neonatal Sennings, 92% (12/13). Six neonatal Sennings were crossovers from the AS group with an 83% survival (5/6).


RESULTS
Intermediate follow-up of 5.2 to 9.2 years revealed no late deaths. In the AS group there was no ventricular failure, no arrhythmias, and one reoperation for supravalvar pulmonic stenosis. In the Senning group, there was no ventricular failure, but significant complications developed in 10 patients: cardiac arrhythmias in 7, tachyarrhythmias requiring pharmacologic therapy in 4, and bradyarrhythmias in 3, 2 requiring permanent pacemaker insertion. Left ventricular outflow tract (subpulmonic) stenosis developed in 3 patients, 1 requiring a left ventricular to pulmonary artery conduit and permanent pacemaker. Systemic atrioventricular valve insufficiency has developed in 3 patients.


CONCLUSIONS
Results at one reporting institution from the CHSS study during this period of transition from late atrial repair (Senning) to neonatal atrial or arterial repair show comparable early mortality in all groups. However, the intermediate results at a mean of 6.7 years reveal fewer arrhythmic and functional complications in the AS group. The possibility of neonatal repair combined with low early and intermediate morbidity and mortality confirm AS as the treatment of choice for d-transposition of the great arteries.
Turley
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California Pacific Medical Center, San Francisco 94115, USA.
Verrier
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D001145:Arrhythmias, Cardiac / Q000209:etiology; D001919:Bradycardia / Q000209:etiology; D002303:Cardiac Output, Low / Q000209:etiology; D018592:Cross-Over Studies; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000601:surgery; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007256:Information Systems; D008297:Male; D010138:Pacemaker, Artificial; D011183:Postoperative Complications; D011666:Pulmonary Valve Stenosis / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D015996:Survival Rate; D013610:Tachycardia / Q000209:etiology; D014188:Transposition of Great Vessels / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000209:etiology; D016276:Ventricular Function