Echocardiographic Midterm and Long-term Outcomes After Arterial Switch Operation for d-Transposition of the Great Arteries: A Single-Institution Experience

Abstract

INTRODUCTION: Arterial switch operation is the preferred surgical management for d-transposition of the great arteries, but it still has long-term complications, which necessitate continued follow-up of patients. This procedure was first performed in this institution in 1991, and after three decades, there is a need to evaluate midterm and long-term outcomes in this population. METHODS: This is a descriptive study on arterial switch operation patients between January 2010 and March 2019 in this institution. The following parameters were collected through review of charts and online health records (Medtrack): preoperative clinical data, surgical technique and immediate postoperative course and complications, echocardiographic results, and current clinical status. The study was approved by the institutional ethics review board of the hospital. RESULTS: Among the 108 patients included in the study, 35 were long-term patients, and 73 were midterm. A total of 27 patients (25%) were lost to follow-up. Among the remaining patients (n = 81), 76 (94%) were alive. The most common postoperative complications were pulmonary stenosis (n = 11), aortic regurgitation (n = 24), and aortic dilatation (n = 2). One patient had reintervention after surgery for severe pulmonic stenosis. Overall survival function was 93.7% after 5 years (95% confidence interval, 0.81–0.98) and 79.4% after 9 years (95% confidence interval, 0.46–0.93). CONCLUSION: Complications seen in this population are similar to those seen in literature. The overall survival rate after 5 years compares to those of other institutions. However, long-term survival rates were lower, which may be due to poor patient follow-up and a high rate of patient attrition over time. To improve future outcomes, strategies should be implemented to promote continuity of care, and parents should be advised regarding the importance of follow-up. KEYWORDS: arterial switch operation, d-TGA, echocardiography, midterm complications, long term complications, survival rate