title: Outcomes of the arterial switch operation for transposition of the great arteries: 25 years of experience.
abstract: BACKGROUND
  Studies on long-term outcomes of the arterial switch operation (ASO) for transposition of the great arteries (TGA) are uncommon. Thus, we sought to determine the long-term outcomes for patients after ASO performed at a single institution over a 25-year period.
  
  
  METHODS
  From 1983 to 2009, 618 patients underwent the ASO for TGA and were reviewed retrospectively.
  
  
  RESULTS
  Overall early mortality was 2.8%. Risk factors for early death on multivariate analysis were resection of left ventricular outflow tract obstruction at time of ASO (p = 0.001), weight less than 2.5 kg at time of ASO (p < 0.001), associated aortic arch obstruction (p = 0.043), and the need for postoperative extracorporeal membrane oxygenation (p < 0.001). Mean follow-up time was 10.6 years (range 2 months to 26.1 years). Late mortality was 0.9%. Reintervention was significantly higher (p < 0.001) in patients with ventricular septal defect or arch obstruction versus those without them (25.2% and 23.4% vs 5.9% at 15- year follow-up). Risk factors for late reintervention were left ventricular outflow tract obstruction at time of ASO (p < 0.001) and a greater circulatory arrest time (p < 0.001). Freedom from at least moderate neoaortic valve regurgitation for the entire cohort was 98.7% (95% confidence interval 96.8 to 99.5%) at 20 years. Mild neoaortic regurgitation was seen in 25.6% of patients at mean follow-up. All patients were free of arrhythmia and heart failure symptoms at last follow-up.
  
  
  CONCLUSIONS
  The ASO can be performed with good long-term results. Patients with associated ventricular septal defect and aortic arch obstruction warrant close follow-up.
authors.affiliation: Royal Children's Hospital, Melbourne, Australia.
authors.forename: Tyson A
authors.initials: TA
authors.lastname: Fricke
authors.forename: Yves
authors.initials: Y
authors.lastname: d'Udekem
authors.forename: Malcolm
authors.initials: M
authors.lastname: Richardson
authors.forename: Clarke
authors.initials: C
authors.lastname: Thuys
authors.forename: Mithilesh
authors.initials: M
authors.lastname: Dronavalli
authors.forename: James M
authors.initials: JM
authors.lastname: Ramsay
authors.forename: Gavin
authors.initials: G
authors.lastname: Wheaton
authors.forename: Leeanne E
authors.initials: LE
authors.lastname: Grigg
authors.forename: Christian P
authors.initials: CP
authors.lastname: Brizard
authors.forename: Igor E
authors.initials: IE
authors.lastname: Konstantinov
mesh_terms: D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D014188:Transposition of Great Vessels / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000601:surgery