Related Experiment Videos
Intermediate-term survival and functional results after arterial repair for transposition of the great arteries
F M Lupinetti1, E L Bove, L L Minich
1Department of Surgery, University of Michigan School of Medicine, Ann Arbor.
Insights
Arterial repair for transposition of the great arteries shows excellent intermediate-term survival. A single pantaloon patch for pulmonary artery reconstruction may reduce reoperation rates for pulmonary artery stenosis.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Cardiovascular Surgery
Background:
- Transposition of the great arteries (TGA) requires arterial repair for corrective treatment.
- Assessing late morbidity and mortality is crucial for evaluating the effectiveness of TGA arterial repair.
Purpose of the Study:
- To evaluate the early and intermediate-term results of arterial repair in patients with TGA.
- To compare the outcomes of different pulmonary artery reconstruction techniques.
Main Methods:
- Retrospective analysis of 126 TGA patients undergoing arterial repair.
- Comparison of pulmonary artery reconstruction using separate patches versus a single pantaloon patch.
- Echocardiography and Doppler flow studies for functional assessment.
Main Results:
- Hospital mortality was 5.5%, decreasing to 3% in the most recent 100 patients.
- Reoperation for pulmonary artery stenosis decreased from 16% to 2% with the single pantaloon patch technique.
- Excellent intermediate-term survival (92% at 5 years) and cardiac function were observed.
Conclusions:
- Arterial repair for TGA offers excellent intermediate-term survival and functional outcomes.
- Pulmonary artery reconstruction with a single pantaloon patch is associated with a reduced need for reoperation.
- Early surgical intervention in TGA patients yields favorable long-term results.
Abstract:
An assessment of late morbidity and mortality is essential before arterial repair can be considered truly corrective for patients with transposition of the great arteries. We describe the early and intermediate-term results in 126 patients who underwent arterial repair. Operation was performed at a median age of 6 days, with 76 patients operated on within the first 7 days of life. Coronary artery anatomy differed from the usual arrangement in 37 patients. Simultaneous procedures included ventricular septal defect closure (35) and repair of interrupted aortic arch (2) or coarctation (5). Hospital mortality was seven of 126 (5.5%), with three deaths among the most recent 100 patients (3%). There were one late, noncardiac death and one late death after reoperation. Reoperation for pulmonary artery stenosis was required in 10 of the first 63 patients (16%), all of whom underwent pulmonary artery reconstruction with separate patches for closure of the coronary excision sites. Of the last 63 patients, all of whom underwent pulmonary artery reconstruction with a single pantaloon-shaped pericardial patch, one (2%) required reoperation for pulmonary artery stenosis. Doppler flow studies and echocardiography performed in 115 of 119 surviving patients at a mean of 12 months after repair demonstrated normal left ventricular function, minimal left ventricular outflow gradients, and no more than trivial aortic regurgitation. Peak gradient across the right ventricular outflow tract was 19 +/- 3 mm Hg in patients with separate pulmonary artery patches and 5 +/- 2 mm Hg in those with a single pantaloon patch (p = 0.0001). Follow-up is 96% complete from 1 month to 8 years after operation (mean 2.5 years). The actuarial survival rate at 5 years, including operative mortality, was 92%. All patients are in sinus rhythm, and none requires antiarrhythmic medications. These data suggest that pulmonary artery reconstruction with a single pantaloon patch may be associated with a decreased requirement for reoperation. Intermediate-term survival and functional results are excellent after arterial repair for transposition of the great arteries.