Early and mid-term outcome of the arterial switch operation for transposition of great arteries: predictors and functional evaluation

Abstract

Objective The aim of this report was to study the early and mid-term outcome in hospital and follow-up mortality, predictors for late pulmonary stenosis (PAS) and insufficiency of neo-aortic valve (neo-AVI) in patients with transposition of great arteries (TGA) and Taussig-Bing malformation undergoing arterial switch operation ( ASO ). Methods Between January 2004 and December 2007, 169 patients (129 male, 40 female; mean age of [(11.71 ± 26.3 ) months] with TGA or Taussig-Bing malformation underwent ASO. The patients were divided into Group Ⅰ (n = 56 ): TGA with intact ventricular septum and Group Ⅱ ( n = 113 ): TGA with ventricular septal defect (VSD). All patients were followed up in out-patient department by ultrasonic cardiogram. The mean follow-up periods was (27.66 ± 14.6 ) months. Multiple logistic regression analysis was performed to find out the risk factors. Results The overall hospital mortality was 11.24% (19/169)and there was no significant difference between the two Groups. With the improving of perioperative management, the hospital mortality decreased from 16.67% in 2004 to 3.92% in 2007. The overall actuarial survival at 1-, 3- and 5-year follow-up was 94.00%,91.33%, and 91.33%, respectively. The multivariate analysis revealed that age above 6 months was a strong predictor for poor postoperative survival. Predictors for neo-AVI were: combined with VSD, age > 6 months and postoperative neo-AVI Z-score > 1. Predictors for moderate to severe PAS were age ＜ 1 months and pulmonary artery plasty with an unstretchable patch. Conclusion ASO remains the optimal choice for treating various forms of TGA with an acceptable early and mid-term outcome regarding overall survival rate. Patients with TGA should be treated as early as possible. Age >6 months is a predictor for poor postoperative survival and neo-AVI. Mismatch between the neo-aortic root and distal aorta may induce neo-AVI. Unstretchable patch in pulmonary artery plasty may induce PAS. Key words: Transposition of great vessels; Cardiac surgical procedures; Risk factors; Arterial switch operation