title: Outcomes of Patients After Arterial Switch Operation: 18 Years of Experience in a Single Medium-Volume Center.
abstract: The objective of this paper was to describe the outcomes in patients submitted to arterial switch operation and to analyze the predictors of in-hospital mortality and further need of re-operation at a single-center institution. Between September 1995 and January 2014, 128 consecutive arterial switch operations were performed. Surgical mortality during this period was analyzed retrospectively, and a follow-up analysis of the survivors was conducted. Surgical era, cardiopulmonary bypass time (p = 0.001), and diagnosis category (p = 0.025) influenced in-hospital mortality. The estimated overall survival for the 91 hospital survivors was 96.8, 96.4, and 96.2 % at 5, 10, and 15 years, respectively. The median follow-up time was 67 months (range 0.71-222 months). Three patients (5 %) presented severe aortic regurgitation. Right ventricle outflow tract systolic gradient by echocardiography was above 60 mmHg in 2 %. Late re-interventions occurred in 12 (13 %) patients with mean time of 64 ± 34 months after the initial procedure. Actuarial freedom from re-interventions at 5, 10, and 15 years was 96.4, 69.7, and 61.9 %, respectively. Arterial switch operation remains the procedure of choice in patients with transposition of great arteries. It can be performed even in middle-volume institutions, leading to the same middle- and long-term outcomes of high-volume institutions. Early high mortality rate may occur due not only to learning curve, but also to cardiopulmonary bypass time and ventricular septal defect closure.
authors.affiliation: Department of Pediatrics, Hospital of Ribeirao Preto Medical School, University of Sao Paulo, Avenida dos Bandeirantes 3900, Ribeirão Preto, SP, 14049900, Brazil. phmanso@fmrp.usp.br.
authors.forename: Paulo H
authors.initials: PH
authors.lastname: Manso
authors.affiliation: Department of Pediatrics, Hospital of Ribeirao Preto Medical School, University of Sao Paulo, Avenida dos Bandeirantes 3900, Ribeirão Preto, SP, 14049900, Brazil.
authors.forename: Fernando T V
authors.initials: FT
authors.lastname: Amaral
authors.affiliation: Department of Pediatrics, Hospital of Ribeirao Preto Medical School, University of Sao Paulo, Avenida dos Bandeirantes 3900, Ribeirão Preto, SP, 14049900, Brazil.
authors.forename: Tarcísio J S
authors.initials: TJ
authors.lastname: Júnior
authors.affiliation: Department of Pediatrics, Hospital of Ribeirao Preto Medical School, University of Sao Paulo, Avenida dos Bandeirantes 3900, Ribeirão Preto, SP, 14049900, Brazil.
authors.forename: Mauro C
authors.initials: MC
authors.lastname: Jurca
authors.affiliation: Department of Internal Medicine, Hospital of Ribeirao Preto Medical School, University of Sao Paulo, Avenida dos Bandeirantes 3900, Ribeirão Preto, SP, 14049900, Brazil.
authors.forename: Jorge
authors.initials: J
authors.lastname: Haddad
authors.affiliation: Department of Surgery and Anatomy, Hospital of Ribeirao Preto Medical School, University of Sao Paulo, Avenida dos Bandeirantes 3900, Ribeirão Preto, SP, 14049900, Brazil.
authors.forename: Walter V A
authors.initials: WV
authors.lastname: Vicente
authors.affiliation: Department of Surgery and Anatomy, Hospital of Ribeirao Preto Medical School, University of Sao Paulo, Avenida dos Bandeirantes 3900, Ribeirão Preto, SP, 14049900, Brazil.
authors.forename: Ricardo N
authors.initials: RN
authors.lastname: Sgarbieri
authors.affiliation: Department of Pediatrics, Hospital of Ribeirao Preto Medical School, University of Sao Paulo, Avenida dos Bandeirantes 3900, Ribeirão Preto, SP, 14049900, Brazil.
authors.forename: Fabio
authors.initials: F
authors.lastname: Carmona
mesh_terms: D001022:Aortic Valve Insufficiency / Q000601:surgery*; D000069278:Arterial Switch Operation / Q000706:statistics & numerical data*; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis; D012086:Reoperation / Q000401:mortality; D012189:Retrospective Studies; D014188:Transposition of Great Vessels / Q000401:mortality* / Q000601:surgery*
keywords: Arterial switch operation; Congenital heart disease; Outcomes