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Rev Esp Cardiol (Engl Ed). 2014 Mar;67(3):181-8. doi: 10.1016/j.rec.2013.06.021. Epub 2013 Nov 12.

Mid-term morbidity and mortality of patients after arterial switch operation in infancy for transposition of the great arteries.

Author information

1
Unidad Intercentro de Cardiopatías Congénitas del Adulto, Área del Corazón, Hospitales Virgen del Rocío y Virgen Macarena, Sevilla, Spain.
2
Servicio de Cardiología Pediátrica, Hospital Infantil Virgen del Rocío, Sevilla, Spain.
3
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.
4
Servicio de Cirugía Cardiaca Pediátrica, Hospital Infantil Virgen del Rocío, Sevilla, Spain.
5
Unidad Intercentro de Cardiopatías Congénitas del Adulto, Área del Corazón, Hospitales Virgen del Rocío y Virgen Macarena, Sevilla, Spain. Electronic address: pgallegogv@ono.com.

Abstract

INTRODUCTION AND OBJECTIVES:

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.

KEYWORDS:

Arterial switch; Corrección anatómica; Outcome; Seguimiento; Transposición de grandes arterias; Transposition of great arteries

PMID:
24774392
DOI:
10.1016/j.rec.2013.06.021
[Indexed for MEDLINE]

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