title: Long-term outcomes of the arterial switch operation for transposition of the great arteries and ventricular septal defect and/or aortic arch obstruction.
abstract: Long-term outcomes after the arterial switch operation (ASO) for complex transposition of the great arteries (TGA) should be clarified.
  
  
  
  A retrospective study was conducted in patients operated on between 1982 and 1998. Overall 220 postoperative survivors, 79.1% with a ventricular septal defect, 13.2% with multiple ventricular septal defects, and 29.1% with aortic arch obstruction, were followed for 17 years (0-28 years).
  
  
  
  The conditional survival rate was 96.7% [95% confidence interval (CI): 94.4-99.1] at 25 years. Late sudden death occurred in 2 asymptomatic patients. The cumulative incidence rate of death or reinterventions was 3.8% (95% CI: 2.9-4.8) at 25 years, with age at ASO <10 days and aortic regurgitation at discharge identified as independent risk factors. The cumulative incidence rate of neoaortic regurgitation was 41.6% (95% CI: 20.5-62.8) at 25 years with an aorto-pulmonary diameter mismatch at the time of the ASO, age at ASO <10 days and aortic regurgitation at discharge identified as independent risk factors. At the last follow-up, 53 patients (24.1%) had neoaortic root dilatation with an aortic sinus z-score ≥3 and 6 of them had a Bentall operation at a median delay of 14.1 years since the ASO. The only independent factors for neoaortic root dilatation were male sex and an aorto-pulmonary diameter mismatch at the time of the ASO.
  
  
  
  Despite a continual rate of reinterventions, long-term survival and cardiovascular outcome are excellent after ASO for complex TGA. Dilatation of the neoaortic root and neoaortic regurgitation may be observed with time and 2 late sudden deaths occurred, justifying a close follow-up in all patients.
authors.affiliation: Department of Pediatric Cardiac Surgery, Marie-Lannelongue Hospital, Paris-Sud University, Paris, France Department of Pediatric Cardiac Surgery, New York Presbyterian Hospital, Columbia University, New York, NY, USA a.baruteau@gmail.com.
authors.forename: Alban-Elouen
authors.initials: AE
authors.lastname: Baruteau
authors.affiliation: Department of Pediatric Cardiac Surgery, Marie-Lannelongue Hospital, Paris-Sud University, Paris, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Vergnat
authors.affiliation: Department of Pediatric Cardiac Surgery, New York Presbyterian Hospital, Columbia University, New York, NY, USA.
authors.forename: David
authors.initials: D
authors.lastname: Kalfa
authors.affiliation: Department of Pediatric Cardiac Surgery, Marie-Lannelongue Hospital, Paris-Sud University, Paris, France.
authors.forename: Jean-Guillaume
authors.initials: JG
authors.lastname: Delpey
authors.affiliation: Department of Pediatric Cardiac Surgery, Marie-Lannelongue Hospital, Paris-Sud University, Paris, France.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Ly
authors.affiliation: Department of Pediatric Cardiac Surgery, Marie-Lannelongue Hospital, Paris-Sud University, Paris, France.
authors.forename: André
authors.initials: A
authors.lastname: Capderou
authors.affiliation: Department of Pediatric Cardiac Surgery, Marie-Lannelongue Hospital, Paris-Sud University, Paris, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Lambert
authors.affiliation: Department of Pediatric Cardiac Surgery, Marie-Lannelongue Hospital, Paris-Sud University, Paris, France.
authors.forename: Emre
authors.initials: E
authors.lastname: Belli
mesh_terms: D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D000069278:Arterial Switch Operation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D014188:Transposition of Great Vessels / Q000601:surgery*; D016896:Treatment Outcome
keywords: Aortic root; Aortic valve; Arterial switch; Congenital heart disease; Great vessel anomalies; Outcomes; Replacement; Transposition