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Related Experiment Videos

The arterial switch operation. An eight-year experience.

J M Quaegebeur, J Rohmer, J Ottenkamp

    The Journal of Thoracic and Cardiovascular Surgery
    |September 1, 1986
    PubMed
    Summary

    The arterial switch repair offers superior outcomes for congenital heart defects like transposition of the great arteries. This surgical technique demonstrates excellent long-term survival and functional status, surpassing previous methods.

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    Area of Science:

    • Cardiovascular Surgery
    • Pediatric Cardiology
    • Congenital Heart Disease

    Background:

    • Transposition of the great arteries (TGA) and double-outlet right ventricle (DORV) are complex congenital heart defects.
    • Arterial switch repair (ASR) has become a primary surgical option for these conditions.
    • Evaluating the long-term efficacy and safety of ASR is crucial for patient management.

    Purpose of the Study:

    • To assess the outcomes of arterial switch repair in patients with TGA and DORV.
    • To identify risk factors associated with mortality after ASR.
    • To compare the effectiveness of ASR with the atrial switch repair.

    Main Methods:

    • Retrospective analysis of 66 patients undergoing ASR between 1977 and 1985.
    • Inclusion of neonates with TGA/intact ventricular septum, infants/children with TGA/ventricular septal defect, and DORV/subpulmonary ventricular septal defect.

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  • Actuarial survival analysis and identification of risk factors for mortality.

    • Main Results:

    • Overall 11-month actuarial survival rate was 81%, with no late deaths among survivors traced up to 8 years.
    • Risk factors for death included low birth weight, TGA with large VSD, DORV with subpulmonary VSD, and patent ductus arteriosus.
    • Early date of operation was a significant risk factor (p=0.004), with predicted 1-year survival in 1985 approaching 99.9% for TGA/intact VSD and 99.7% for TGA/VSD or DORV.
    • Late functional status was excellent, with 96% sinus rhythm in survivors.

    Conclusions:

    • Arterial switch repair demonstrates superior outcomes compared to atrial switch repair for TGA and DORV.
    • Continuous improvements in surgical timing and technique have dramatically improved ASR survival rates.
    • ASR is a safe and effective procedure with excellent long-term functional results for complex congenital heart defects.