Mid-term morbidity and mortality of patients after arterial switch operation in infancy for transposition of the great arteries.
OBJECTIVE
The arterial switch operation is currently the preferred surgical approach for complete transposition of the great arteries. We sought to determine the mid-term results of this intervention.


METHODS
A single-institution retrospective review of clinical records of all consecutive patients who underwent the arterial switch surgery between 1985 and 2010.


RESULTS
Overall, the operation was performed on 155 patients (68% boys) at a median age of 13 days: 64% with an intact septum, 46% with a ventricular septal defect, and 4.5% with associated aortic arch anomaly. The usual coronary pattern was found in 63%. Palliative surgery was performed prior to arterial switch in 6.5%. In all, 137 perioperative survivors were followed for a median of 6 years. Late mortality was 2.9%, of which 50% was due to coronary complications. Eighteen percent required surgical and/or percutaneous reintervention: 95.6% for right-sided obstruction and 4.3% for aortic regurgitation. At last follow-up, 92% had functional class I symptoms and 95% were free of arrhythmias. The left ventricular ejection fraction was greater than 55% in 95%, 28% had neoaortic regurgitation (78% mild regurgitation), and 31% had right ventricular outflow tract obstruction with a mean gradient according to echocardiography greater than 25mmHg.


CONCLUSIONS
Mid-term survival of patients after arterial switch operation is excellent and their functional status is good. However, a few patients have residual lesions and a need for further intervention during follow-up, mostly for right-sided obstructions. Late mortality was uncommon and was related to coronary complications. Neoaortic root dilation and regurgitation are not major issues in early adulthood, but the long-term course of these lesions is still unknown.
Unidad Intercentro de Cardiopatías Congénitas del Adulto, Área del Corazón, Hospitales Virgen del Rocío y Virgen Macarena, Sevilla, Spain.
María José
MJ
Rodríguez Puras
Unidad Intercentro de Cardiopatías Congénitas del Adulto, Área del Corazón, Hospitales Virgen del Rocío y Virgen Macarena, Sevilla, Spain.
Luisa
L
Cabeza-Letrán
Unidad Intercentro de Cardiopatías Congénitas del Adulto, Área del Corazón, Hospitales Virgen del Rocío y Virgen Macarena, Sevilla, Spain.
Manuela
M
Romero-Vazquianez
Servicio de Cardiología Pediátrica, Hospital Infantil Virgen del Rocío, Sevilla, Spain.
José
J
Santos de Soto
Unidad Intercentro de Cardiopatías Congénitas del Adulto, Área del Corazón, Hospitales Virgen del Rocío y Virgen Macarena, Sevilla, Spain; Servicio de Cirugía Cardiaca Pediátrica, Hospital Infantil Virgen del Rocío, Sevilla, Spain.
Reza
R
Hosseinpour
Servicio de Cirugía Cardiaca Pediátrica, Hospital Infantil Virgen del Rocío, Sevilla, Spain.
Mauro
M
Gil Fournier
Servicio de Cirugía Cardiaca Pediátrica, Hospital Infantil Virgen del Rocío, Sevilla, Spain.
Antonio
A
Alvarez Madrid
Unidad Intercentro de Cardiopatías Congénitas del Adulto, Área del Corazón, Hospitales Virgen del Rocío y Virgen Macarena, Sevilla, Spain; Servicio de Cirugía Cardiaca Pediátrica, Hospital Infantil Virgen del Rocío, Sevilla, Spain.
Antonio
A
González
Unidad Intercentro de Cardiopatías Congénitas del Adulto, Área del Corazón, Hospitales Virgen del Rocío y Virgen Macarena, Sevilla, Spain.
Pilar
P
Pérez
Unidad Intercentro de Cardiopatías Congénitas del Adulto, Área del Corazón, Hospitales Virgen del Rocío y Virgen Macarena, Sevilla, Spain. Electronic address: pgallegogv@ono.com.
Pastora
P
Gallego
D006348:Cardiac Surgical Procedures; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D014188:Transposition of Great Vessels / Q000401:mortality* / Q000601:surgery*
Arterial switch; Corrección anatómica; Outcome; Seguimiento; Transposición de grandes arterias; Transposition of great arteries