Anatomical risk factors for mortality and cardiac morbidity after arterial switch operation.
BACKGROUND
The arterial switch operation (ASO) is the treatment of choice for transposition of the great arteries.


METHODS
Anatomical risk factors on mortality and morbidity were analyzed retrospectively in 312 patients who underwent ASO between 1982 and 1997.


RESULTS
Survival was 95%, 92%, and 92% after 30 days, 5, and 10 years, respectively. Operative survival improved after 1990 to 97% (p < 0.001). Risk factors for operative mortality were complex anatomy (p = 0.018), coronary anomalies (p = 0.008), and prolonged bypass time (p < 0.001). Determinants of late mortality were coronary distribution (p = 0.03), position of the great arteries (p = 0.0095), bypass time (p = 0.047), and aortic coarctation (p = 0.046). After a follow-up of 3.6 +/- 2.7 years (0.1 to 14.9 years), 98% had good left ventricle function, 94% were in sinus rhythm, 2.4% had moderate to severe pulmonary stenosis, 0.3% had significant aortic regurgitation, and 1% had coronary stenosis. Freedom from reoperation was 100%, 96%, and 94% after 1, 5, and 10 years, respectively. No preoperative anatomic parameter correlated with long-term morbidity.


CONCLUSIONS
ASO can be performed with low operative mortality (< 5%) and long-term morbidity. Malformations associated with complex transposition of the great arteries influence early and late mortality.
Daebritz
S H
SH
Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH, Aachen, Germany. sabine.daebritz@hch.med.uni-muenchen.de
Nollert
G
G
Sachweh
J S
JS
Engelhardt
W
W
von Bernuth
G
G
Messmer
B J
BJ
D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000401:mortality*; D012086:Reoperation; D012307:Risk Factors; D015996:Survival Rate; D014188:Transposition of Great Vessels / Q000401:mortality / Q000601:surgery*