Midterm results of the neonatal arterial switch operation. A review

Complete transposition of the great arteries is a relatively common anomaly, which comprises 5 to 7% of all instances of cardiac malformations. Given the decreasing mortality rates associated with a neonatal arterial switch operation and the unacceptable morbidity associated with atrial baffle operations, it is reasonable to accept this operation as the procedure of choice for the treatment of the complete transposition of the great arteries. It represents a major improvement since it does not introduce any additional intracardiac anomaly, restores the left ventricle to its natural systemic function, and maintains the sinus node function. Long-term survival exceeds 90%. Midterm general health status is encouraging. To date, there have been limited long-term follow-up studies after a neonatal arterial switch operation, although the intermediate data are promising. It will be necessary to determine whether the theorized benefits of the anatomic repair are realized, since experience is limited to the last 15 years. Translocation of the coronary arteries remains one of the most difficult aspects of the operation and late mortality appears to coincide with coronary artery events with sudden death secondary to acute myocardial infarction being reported in 1-2% of hospital survivors. Supravalvar pulmonary stenosis, neoaortic root dilation and valvar regurgitation, bronchopulmonary collateral arteries, coronary insufficiency, and myocardial perfusion abnormalities are other specific areas which require close observation and further investigation.