Morbidity of the arterial switch operation

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• The arterial switch operation (ASO) is a standard procedure for treating congenital heart defects.
• While ASO has low mortality, significant morbidity persists, especially in complex cases.

Purpose of the Study:

• To evaluate morbidity associated with simple versus complex arterial switch operations (ASO).
• To identify specific risk factors contributing to morbidity after ASO.

Main Methods:

• 101 patients undergoing ASO were classified as simple (n=52) or complex (n=49) using the Aristotle score.
• Morbidity outcomes included ventilation time, postextubation hospital stay, and a composite morbidity index.
• Multivariate analysis identified predictors of increased morbidity.

Main Results:

• Zero operative mortality was observed.
• Complex ASO (39%) had significantly higher major complication rates than simple ASO (12%).
• Unplanned reoperation was the most frequent complication; aortic arch repair and malaligned commissures predicted higher morbidity.

Conclusions:

• Morbidity is significantly elevated in complex arterial switch operations.
• Aortic arch repair and malaligned commissures are independent anatomic risk factors for ASO morbidity.
• Primary diagnosis, low weight, or coronary patterns did not significantly increase morbidity.