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Late results (50 to 182 months) of the Jatene operation
F B Jatene1, I B Bosisio, M B Jatene
1Heart Institute, Medical School, University of São Paulo, Brazil.
Insights
The Jatene operation for transposition of the great arteries (TGA) shows good long-term outcomes. Most survivors maintain good clinical condition with normal left ventricular function, despite some developing mild dysfunctions.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Transposition of the great arteries (TGA) is a critical congenital heart defect.
- The Jatene operation (arterial switch operation) is a primary surgical repair for TGA.
- Long-term outcomes after Jatene operation require continued evaluation.
Purpose of the Study:
- To assess the long-term clinical outcomes and anatomical status of patients who underwent the Jatene operation for TGA.
- To evaluate the incidence of reoperations, complications, and overall patient condition after corrective surgery.
Main Methods:
- Retrospective analysis of 116 patients with TGA undergoing Jatene operation before June 1987.
- Follow-up period ranging from 50 to 182 months.
- Assessment of clinical condition, anatomical normality, left ventricular function, and need for reintervention.
Main Results:
- Early postoperative mortality was 20.7%.
- Late mortality included 5 deaths due to endocarditis, gastroenteritis, sudden death, and reoperation for pulmonary stenosis.
- Of 73 survivors, 32.9% were anatomically normal, 30.1% had asymptomatic dysfunctions, and 11% required reoperation/angioplasty for pulmonary stenosis.
- 98% exhibited normal left ventricular function.
Conclusions:
- The Jatene operation provides favorable long-term results for TGA patients.
- Most survivors achieve good clinical status with preserved left ventricular function.
- Ongoing monitoring is essential for managing potential late complications like pulmonary stenosis.
Abstract:
Between May 1975 and August 1991, 184 patients with transposition of the great arteries (TGA) were operated upon by Jatene operation. One hundred and sixteen underwent corrective surgery prior to June 1987 with a follow-up period of between 50 and 182 months. The ages of these 116 patients ranged from 1 day to 84 months (11.53 +/- 15.98). Eleven percent were less than 1 month old, 38% were between 1 and 6 months, 29% between 7 and 12 months and 22% were older than this. Eighty-eight patients (76%) were boys and the weight ranged from 2.4 to 17.0 kg (6.39 +/- 3.38). Thirty-eight patients (20.7%) died in the immediate postoperative period. Of the survivors, 5 died in the late follow-up between 9 and 66 months (endocarditis at 9 and 66 months; gastroenteritis at 20 months; sudden death at 48 months; and during reoperation for relief of pulmonary stenosis (PS) at 60 months). Of the surviving 73 patients, 24 (32.9%) are anatomically normal at a mean period of 92.5 months postoperatively. Twenty-two (30.1%) have dysfunctions without clinical repercussion. Nineteen (26%) have had no recent evaluation and 8 (11%) were submitted to reoperation or angioplasty for relief of PS. Ninety-eight percent of the patients have normal left ventricular function. The majority of the patients surviving 50 to 182 months are in good clinical condition and if dysfunctions are present these show no progression or severe hemodynamic alterations.