Mid-to-long-term outcomes of the arterial switch operation in children with transposition of great arteries

Abstract

Objective To investigate the mid-to-long-term outcomes as well as development of aortic valve regurgitation and stenosis following aortic and pulmonary anastomosis after arterial switch operation (ASO) in children with transposition of the great arteries (TGA).Methods A total of 166 TGA children who underwent ASO in our institute between January 2003 and December 2009 were included in this study.The patients with ventricular septal defect (VSD) were allocated to Group Ⅰ (n=94) and those with intact ventricular septum to Group Ⅱ (n=72).All the patients were followed up in out-patient department by echocardiogram for aortic valve regurgitation and stenosis following aortopulmonary anastomosis.Results Fourteen patients from Group Ⅰ and 10 from Group Ⅱ died after ASO respectively.The mean length of follow-up was (57.41±15.45) months.Neoaortic valve regurgitation was detected in 51 cases,mostly within 3 to 5 years post-ASO.Correlation analysis revealed that the reflux area was positively correlated with the length of follow-up (r=0.436,P=0.028).Aortic anastomotic stenosis (defined as pressure gradient ＞50 mm Hg,1 mm Hg=0.133 kPa) did not occur in all the patients,whereas pulmonary anastomotic stenosis (defined as pressure gradient ＞50 mm Hg) was found in 6.25％ and 3.23％ respectively,of patients during follow-up from Group Ⅰ (5 out of 80) and Group Ⅱ (2 out of 62).Conclusions ASO may be an ideal surgical option for TGA,with good mid-to-long-term outcomes.Regular post-surgical follow-up will help ensure a better prognosis after ASO. Key words: Heart defects, congenital; Transposition of the great artery; Arterial switch operation; Postoperative complications ; Follow-up studies