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Arterial switch in simple and complex transposition of the great arteries
F S Idriss1, M N Ilbawi, S Y DeLeon
1Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, Chicago, IL 60614.
Insights
The arterial switch procedure offers excellent outcomes for infants with transposition of the great arteries, with or without ventricular septal defects. This surgical repair shows improved results, especially when performed on neonates.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease Repair
- Great Arteries Anomalies
Background:
- Transposition of the great arteries (TGA) is a critical congenital heart defect.
- Surgical repair aims to restore normal arterial and venous connections.
- The arterial switch operation (ASO) is a primary surgical option for TGA.
Purpose of the Study:
- To evaluate the outcomes of the arterial switch operation for TGA.
- To assess the efficacy of ASO in infants with intact ventricular septum and VSD.
- To analyze early and late mortality and morbidity associated with ASO.
Main Methods:
- Retrospective review of 53 patients undergoing arterial switch for TGA since 1983.
- Patients categorized into three groups based on ventricular septum status and prior procedures.
- Data collected on demographics, surgical details, mortality, morbidity, and long-term follow-up.
Main Results:
- Overall early mortality was 9.4%, with lower rates in neonates and after an initial learning curve.
- Late mortality occurred in 3 patients due to infection, fever, and aspiration.
- Surviving patients demonstrated good functional status, normal sinus rhythm, and preserved ventricular function, with minimal aortic insufficiency.
Conclusions:
- The arterial switch operation yields excellent results for TGA repair, including cases with ventricular septal defects.
- Outcomes significantly improve with surgical experience and are particularly favorable in neonates.
- ASO is a safe and effective treatment for transposition of the great arteries.
Abstract:
Arterial switch for repair of transposition of the great arteries was performed on 53 patients since October 1983. These patients were divided into three groups: group I, 25 infants with an intact ventricular septum who had primary repair in the first month of life (2 to 34 days of age, mean 9.7 +/- 6.6); group II, 13 patients with an intact ventricular septum who had anatomic repair after a preliminary procedure (pulmonary artery banding in 13, shunt in 10, atrial septectomy in 1); and group III, 15 infants with transposition of the great arteries and ventricular septal defect. In group III, six patients had Taussig-Bing abnormality, nine had previous pulmonary artery banding, three had coarctation of the aorta repaired earlier in life, and four were less than 2 weeks old. Overall early mortality was 9.4% (5/53: group I 8%, group II 7.6%, group III 13.3%). Two late deaths occurred in group II 10 and 12 weeks postoperatively after infection and high fever. A third late death 18 weeks postoperatively was due to aspiration in an infant with Goldenhar's syndrome. Mortality and morbidity decreased significantly after an initial learning period (no deaths from July 1985 to March 1987 overall, and none in the last 15 infants operated on in group I). The surviving 45 patients are doing well. All have normal sinus rhythm. Two had transient asymptomatic arrhythmias. Left and right ventricular function assessed by echocardiogram and postoperative cardiac catheterization were within normal ranges in all but two patients, one with pulmonary artery stenosis and one (Taussig-Bing abnormality with two large ventricular septal defects) with severe pulmonary vascular disease (9.6 units) observed before anatomic repair. The right ventricular pressure at catheterization ranged from 27 to 42 mm Hg in 12 patients and was 55 mm Hg in two. There was no aortic stenosis. Aortic insufficiency was trivial in three patients and mild in one. We conclude that excellent results can be obtained with arterial switch for transposition of the great arteries with or without ventricular septal defect, especially in neonates.