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Related Experiment Videos

Twenty-five years' experience with the arterial switch operation.

P A Hutter1, D L Kreb, S F Mantel

  • 1Children's Heart Center of the Wilhelmina Children's Hospital, Room No. KG.01.319.0, University Medical Center, PO Box 85090, 3508 AB Utrecht, The Netherlands. p.hutter@wkz.azu.nl

The Journal of Thoracic and Cardiovascular Surgery
|September 27, 2002
PubMed
Summary

The arterial switch operation offers good long-term outcomes for transposition of the great arteries, with now-low mortality. Key concerns include pulmonary stenosis and coronary artery disease, which can lead to arrhythmias.

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Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • The arterial switch operation (ASO) was developed in 1976 for transposition of the great arteries (TGA).
  • ASO has largely replaced atrial palliative procedures for TGA correction.
  • Long-term results of ASO are crucial for understanding its lasting impact.

Purpose of the Study:

  • To evaluate the long-term clinical outcomes of the arterial switch operation.
  • To assess functional status, cardiac function, and potential complications following ASO.
  • To analyze mortality rates and identify long-term morbidities associated with ASO.

Main Methods:

  • A retrospective review of 195 patients who underwent ASO between 1977 and 2000.
  • Evaluation of patient outcomes including functional class, pulmonary stenosis, left ventricular function, arrhythmias, aortic valve status, and coronary artery disease.

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  • Analysis of perioperative and late mortality, reinterventions, and specific complication rates.

    • Main Results:

    • Perioperative mortality decreased significantly over time, from 15% overall to 4% (complex TGA) and 0% (simple TGA) in the last 5 years.
    • Late mortality occurred in 2 of 151 survivors (pulmonary hypertension, ventricular fibrillation).
    • Most survivors (145/149) were in New York Heart Association functional class I or II; pulmonary stenosis was the most common complication (26 patients), requiring 45 reinterventions.

    Conclusions:

    • The arterial switch operation demonstrates favorable long-term clinical outcomes with significantly reduced perioperative mortality.
    • Pulmonary stenosis and coronary artery disease are the predominant long-term morbidities.
    • The potential for lethal arrhythmias necessitates ongoing surveillance and management.