The arterial switch operation has developed into the procedure of choice for transposition of the great arteries (TGA) and associated great vessel malposition anomalies, even though there are potential problems of semilunar valvular incompetence,
coronary insufficiency, and supravalvular aortic and pulmonary stenosis.
One hundred and six patients, 95 with TGA, 9 with Taussig-Bing double outlet right ventricle, and 2 with great vessel malposition anomalies, underwent anatomic correction from November 1987 to December 1994. Ages at the operation ranged from 1
day
to
96months (mean 4.1*11.2 months). The overall early mortality rate was 25% (27/106). The mortality in patients with unusual coronary artery patterns was significantly higher than that of usual patterns (63.6% versus 23%, p<0.001). There were 7
late
deaths (6.6%) with a mean follow-up of 32months (range from 1 to 86 months). The actuarial survival rate at 7 years, including operative mortality, was 65.2%. Survivors showed relatively good postoperative status including LV contractility
without
significant RVOT and LVOT obstruction. Seventy four patients (95%, 75/79) were in sinus rhythm and none required antiarrhythmic medications.
It is anticipated that arterial switch repair will be established as the optimal approach to the treatment of TGA and other complex congenital heart diseases.
(Korean J Thorac Cardiovasc Surg 1995;28:237-46)
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