Is the arterial switch operation still a challenge in small centers?

Area of Science:

• Pediatric Cardiac Surgery
• Congenital Heart Disease
• Surgical Outcomes

Background:

• The arterial switch operation (ASO) has advanced significantly, enabling widespread adoption for treating transposition of the great arteries (TGA).
• Improvements in surgical timing, technique, and perioperative care have led to excellent mid-term results in specialized centers.
• This study evaluates the safety and efficacy of ASO in a smaller, non-specialized institution.

Purpose of the Study:

• To assess the safety and feasibility of performing the arterial switch operation (ASO) for transposition of the great arteries (TGA) in a small center.
• To review the early experience with ASO in a consecutive series of patients.
• To evaluate the impact of modified ultrafiltration on perioperative outcomes.

Main Methods:

• A retrospective review of 39 consecutive patients undergoing TGA repair via ASO between April 1992 and the study period.
• Patients included simple TGA, TGA with VSD, and Taussig-Bing heart with aortic coarctation, with 34 neonates undergoing repair.
• Surgical modifications focused on coronary relocation, pulmonary artery reconstruction, and VSD/aortic arch repair.

Main Results:

• An overall early mortality of 2.6% (1 patient) was observed, attributed to coronary relocation issues.
• Implementation of modified ultrafiltration significantly decreased mean ICU stay from 5 ± 4 days to 2 ± 1 days (P < 0.05).
• Three patients required reoperation for residual defects; no late deaths occurred, with all survivors asymptomatic at a mean follow-up of 26 months.

Conclusions:

• Neonatal repair of TGA using ASO can be safely performed in smaller centers, even with complex coronary anomalies and associated defects.
• Modified ultrafiltration is a valuable adjunct, improving early outcomes in neonates undergoing ASO.
• The study demonstrates successful ASO implementation outside of major cardiac centers.