Open Access Research article

Midterm results after arterial switch operation for transposition of the great arteries: a single centre experience

Aron Frederik Popov14*, Theodor Tirilomis1, Michael Giesler1, Kasim Oguz Coskun1, Jose Hinz2, Gerd Gunnar Hanekop2, Verena Gravenhorst3, Thomas Paul3 and Wolfgang Ruschewski1

Author Affiliations

1 Department of Thoracic and Cardiovascular Surgery, University of Göttingen, Robert-Koch-Straße, 40 37099, Göttingen, Germany

2 Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany

3 Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, University of Göttingen, Göttingen, Germany

4 Presented in part at the 8th International Conference Pediatric Mechanical Circulatory Support Systems & Pediatric Cardiopulmonary Perfusion June 13–16, 2012, Istanbul, Turkey

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Journal of Cardiothoracic Surgery 2012, 7:83  doi:10.1186/1749-8090-7-83

Published: 7 September 2012

Abstract

Background

The arterial switch operation (ASO) has become the surgical approach of choice for d-transposition of the great arteries (d-TGA). There is, however an increased incidence of midterm and longterm adverse sequelae in some survivors. In order to evaluate operative risk and midterm outcome in this population, we reviewed patients who underwent ASO for TGA at our centre.

Methods

In this retrospective study 52 consecutive patients with TGA who underwent ASO between 04/1991 and 12/1999 were included. To analyze the predictors for mortality and adverse events (coronary stenoses, distortion of the pulmonary arteries, dilatation of the neoaortic root, and aortic regurgitation), a multivariate analysis was performed. The follow-up time was ranged from 1–10 years (mean 5 years, cumulative 260 patient-years).

Results

All over mortality rate was 15.4% and was only observed in the early postoperative period till 1994. The predictors for poor operative survival were low APGAR-score, older age at surgery, and necessity of associated surgical procedures. Late re-operations were necessary in 6 patients (13.6%) and included a pulmonary artery patch enlargement due to supravalvular stenosis (n = 3), coronary revascularisation due to coronary stenosis in a coronary anatomy type E, aortic valve replacement due to neoaortic valve regurgitation (n = 2), and patch-plasty of a pulmonary vein due to obstruction (n = 1). The dilatation of neoaortic root was not observed in the follow up.

Conclusions

ASO remains the procedure of choice for TGA with acceptable early and late outcome in terms of overall survival and freedom of reoperation. Although ASO is often complex and may be associated with morbidity, most patients survived without major complications even in a small centre.

Keywords:
Arterial switch operation; Transposition of great arteries; Midterm outcome