Selective timing for the arterial switch operation.
BACKGROUND
To determine outcomes for the arterial switch operation individualized according to the underlying anatomy and clinical status.


METHODS
A retrospective review of a consecutive series of infants less than 90 days of age who underwent the arterial switch operation at a single institution.


RESULTS
From July 1993-April 2001, 117 infants underwent an arterial switch operation before 90 days of age. Seventy-five patients (64%) had transposition of the great arteries with intact ventricular septum with the aim of operation before 14 days of age; however, 8 of these patients had delayed presentation (range 15-46 days). Thirty-five patients (30%) had transposition with a ventricular septal defect (30 patients) or double outlet right ventricle (5 patients) and normal arch anatomy and were repaired within the first 90 days of life depending on the severity of heart failure at a median of 12 days of age (range 3-83 days). Seven patients (6%) had associated aortic coarctation (5 patients) or interrupted aortic arch (2 patients). One patient died during hospitalization (0.85% hospital mortality) and one patient died from noncardiac causes during a median follow-up of 35 months (1.7% total mortality). Four patients required intervention during follow-up (3.4%) for new aortic coarctation (2 patients), supravalvar pulmonic stenosis (1 patient), or right hemi-diaphragm paralysis (1 patient).


CONCLUSIONS
Individualized timing for the arterial switch operation within the first ninety days of life produces excellent survival rates for all types of transposition physiology with the expectation of a satisfactory course during follow-up.
Duncan
Brian W
BW
Department of Pediatric and Congenital Heart Surgery, The Children's Hospital at The Cleveland Clinic, Cleveland, Ohio 44195, USA. duncanb@ccf.org
Poirier
Nancy C
NC
Mee
Roger B B
RB
Drummond-Webb
Jonathan J
JJ
Qureshi
Athar
A
Mesia
C Igor
CI
Graney
June A
JA
Malek
Cheryl L
CL
Latson
Larry A
LA
D003330:Coronary Vessel Anomalies / Q000150:complications; D004310:Double Outlet Right Ventricle / Q000150:complications / Q000601:surgery; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011183:Postoperative Complications; D012121:Respiration, Artificial; D012189:Retrospective Studies; D014188:Transposition of Great Vessels / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome