Arterial Switch Operation: Long-term Outcome

pp. 418-425

Abstract

Background: Arterial switch is the surgical procedure of choice for transposition of the great arteries. However, its outcome is not free from adverse events.

Objective: The aim of this study was to evaluate the mid- and long-term outcome of this surgery at our hospital.
Methods: The study analyzed 224 patients who underwent the Jatene operation at our institution with mean follow-up of 7.6 years (±5.4 years).

Results: The survival rate at 15 years was 98%, with all survivors currently in functional class I-II and with adequate ventricular function. Thirty-nine patients (17.4%) evolved with significant pulmonary stenosis, mainly located at the supravalvular level (94.8%). Twelve percent of patients developed aortic root dilation and 10.3% significant aortic regurgitation. The latter was associated with aortic root dilation (p=0.0000), prior left ventricular preparation (p=0.001) and aortic regurgitation in the immediate postoperative period (p=0.01). Coronary artery lesions were detected in 5 patients (2.2%) and arrhythmias in 4 (1.8%). Freedom from reintervention at 5, 10 and 15 years was 94%, 86% y 58%, respectively, with pulmonary stenosis as the leading cause for reintervention. Mortality was 0.9% (2 patients) during follow-up, and it was associated with coronary artery involvement (p=0.0000) and development of arrhythmias (p=0.0000).

Conclusions:– The arterial switch operation has excellent long-term survival.

– The most frequent adverse event during follow-up was pulmonary stenosis.

-  Significant aortic regurgitation was associated with neo-aortic root dilation, prior left ventricular preparation and aortic regurgitation in the immediate postoperative period.

– There was low incidence of coronary artery obstruction and arrhythmias, but these were associated with mortality.