The arterial switch operation in Europe for transposition of the great arteries: a multi-institutional study from the European Congenital Heart Surgeons Association.
OBJECTIVE
This study analyzes the results of the arterial switch operation for transposition of the great arteries in member institutions of the European Congenital Heart Surgeons Association.


METHODS
The records of 613 patients who underwent primary arterial switch operations in each of 19 participating institutions in the period from January 1998 through December 2000 were reviewed retrospectively.


RESULTS
A ventricular septal defect was present in 186 (30%) patients. Coronary anatomy was type A in 69% of the patients, and aortic arch pathology was present in 20% of patients with ventricular septal defect. Rashkind septostomy was performed in 75% of the patients, and 69% received prostaglandin. There were 37 hospital deaths (operative mortality, 6%), 13 (3%) for patients with an intact ventricular septum and 24 (13%) for those with a ventricular septal defect (P < .001). In 36% delayed sternal closure was performed, 8% required peritoneal dialysis, and 2% required mechanical circulatory support. Median ventilation time was 58 hours, and intensive care and hospital stay were 6 and 14 days, respectively. Although of various preoperative risk factors the presence of a ventricular septal defect, arch pathology, and coronary anomalies were univariate predictors of operative mortality, only the presence of a ventricular septal defect approached statistical significance (P = .06) on multivariable analysis. Of various operative parameters, aortic crossclamp time and delayed sternal closure were also univariate predictors; however, only the latter was an independent statistically significant predictor of death.


CONCLUSIONS
Results of the procedure in European centers are compatible with those in the literature. The presence of a ventricular septal defect is the clinically most important preoperative risk factor for operative death, approaching statistical significance on multivariable analysis.
Sarris
George E
GE
Onassis Cardiac Surgery Center, Athens, Greece. gsarris@hol.gr
Chatzis
Andrew C
AC
Giannopoulos
Nicolas M
NM
Kirvassilis
George
G
Berggren
Hakan
H
Hazekamp
Mark
M
Carrel
Thierry
T
Comas
Juan V
JV
Di Carlo
Duccio
D
Daenen
Willem
W
Ebels
Tjark
T
Fragata
Josè
J
Hraska
Victor
V
Ilyin
Vladimir
V
Lindberg
Harald L
HL
Metras
Dominique
D
Pozzi
Marco
M
Rubay
Jean
J
Sairanen
Heikki
H
Stellin
Giovanni
G
Urban
Andreas
A
Van Doorn
Carin
C
Ziemer
Gerhard
G
D005060:Europe; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D014188:Transposition of Great Vessels / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods