ANATOMIC REPAIR OF TRANSPOSITION OF GREAT-ARTERIES WITH VENTRICULAR SEPTAL-DEFECT AND AORTIC-ARCH OBSTRUCTION - ONE-STAGE VERSUS 2-STAGE PROCEDURE

Between September 1, 1982, and March 1, 1992, 40 patients underwent an atomic repair of transposition of the great arteries, ventricular sept al defect, and aortic arch obstruction. In group I, 26 patients (65%) underwent repair in a two-stage procedure, phases A and B. Phase A inc luded repair of the aortic arch obstruction with (16 patients) or with out (10 patients) pulmonary artery banding through a left thoracotomy (mean age 18.7 +/- 23.4 days). There were three deaths and three reope rations. Phase B included an arterial switch operation with closure of the ventricular septal defect (mean age 95.5 +/- 122 days). There wer e five early deaths and two late deaths. Eight patients required reope ration. Mean delay between phase A and phase B was 77.5 +/- 109 days. In group I, there were eight early and two late deaths, and 11 patient s required reoperation. The mean stay in the intensive care unit was 2 4.7 +/- 20 days. Mean follow-up of 59.6 +/- 21.4 months was completed in all survivors. All but one were in New York Heart Association class I without medication. Actuarial survival rate and rate of freedom fro m reoperation at 5 years were 57.5% and 49.9%, respectively. In group II, 14 patients (35%) had a one-stage procedure through midsternotomy: an arterial switch operation with closure of the ventricular septal d efect and repair of the aortic arch obstruction (mean age 10.2 +/- 5.5 days). There were two early deaths (14.2%) and one late death after r eoperation for overlooked multiple ventricular septal defects. Two pat ients required reoperation. The mean stay in the intensive care unit w as 11.7 +/- 2.5 days. Mean follow-up of 22.4 +/- 16.7 months was achie ved in all survivors. They were all in New York Heart Association clas s I without medication. Actuarial survival rate and rate of freedom fr om reoperation at 3 years were 78.5% and 81.5%, respectively. The one- stage procedure allowed complete repair in neonates without the need f or multiple operations. We believe that it may decrease early mortalit y rates (14.2% versus 30.7%), reduce the reoperation rate and cumulati ve stay in the intensive care unit (11.7 days versus 24.7 days, p = No t significant), and significantly decrease the overall rate of morbidi ty (p < 0.01). However, requirements for surgical intervention with a one-stage or a two-stage procedure must include accurate assessments o f intracardiac and aortic arch anatomy.