Surgical management of transposition of the great arteries

Abstract

From January 1983 through December 1991 470 patients underwent an arterial switch operation (ASO). 281 (59.7%) had transposition of the great arteries (TGA) with intact ventricular septum (IVS) and 189 (40.3%) had a ventricular septal defect (VSD). The overall hospital mortality for ASO was 6.3%, but 0.6% (1/155) in the last 155 consecutive patients with TGA/IVS. Of 9 late deaths (1.9%) 5 were due to coronary artery obstruction. 2 were found related to pulmonary vascular obstructive disease and 2 were unrelated to ASO. Cardiac catheterization in 244 late survivors revealed postoperative, supravalvular pulmonary stenosis in 2% of patients. Residual shunts on ventricular levels greater than QP/QS=1.5/1.0 were measured in 4 patients. No regional wall motion abnormalities were detected and left ventricular function appeared normal in all patients 2 years after surgery. One year after surgery 98% of patients presented in sinus rhythm. The favourable early and midterm results of the ASO as a primary operation continue to make it the preferred approach for the neonate with TGA/IVS and TGA/VSD whenever possible. The rapid two-stage approach (preliminary pulmonary artery banding and shunt followed by ASO after 7 days) is applicable for older patients with TGA/IVS.