The Arterial Switch Operation in the Developing World: Risk Factors and Current Outcomes

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Limited data exist on arterial switch operation outcomes in developing countries.
• This study addresses midterm outcomes and risk factors at a high-volume center in Vietnam.

Purpose of the Study:

• To evaluate the midterm outcomes of the arterial switch operation.
• To identify risk factors for mortality and morbidity in patients undergoing the procedure.

Main Methods:

• Retrospective review of 608 patients (2010-2021).
• Included patients with transposition of the great arteries (TGA) and double-outlet right ventricle TGA (DORV-TGA).

Main Results:

• Overall early mortality was 5.9%, late mortality 1%; 10-year survival was 93%.
• Risk factors for mortality included low weight (<3 kg), prolonged aortic cross-clamp time, and re-cross-clamping.
• Higher reoperation rates were observed in DORV-TGA patients (10-year freedom from reoperation: 94%).

Conclusions:

• Arterial switch operation outcomes are satisfactory in low- and middle-income countries.
• Patient weight and procedural complexity remain challenges.
• Close follow-up is crucial for DORV-TGA and single coronary artery patients.