SINGLE-STAGE ARTERIAL SWITCH WITH AORTIC-ARCH ENLARGEMENT FOR TRANSPOSITION COMPLEXES WITH AORTIC-ARCH OBSTRUCTION

Background. Patients with transposition complexes and aortic arch obst ruction are a surgical challenge with significant mortality. We have a dopted an aggressive approach of concurrent aortic arch repair and art erial switch operation with excellent results. Methods. Since 1989, 12 of 13 patients with aortic arch obstruction and transposition of the great arteries or double-outlet right ventricle with subpulmonary vent ricular septal defect have undergone complete single-stage repair. One patient underwent a two-stage repair because of hemodynamic instabili ty. The median age of repair was 27 days and the median weight was 3.5 kg. Surgical technique involved the arterial switch operation and ven tricular septal defect closure when present in 12 patients. One patien t with severe subaortic stenosis underwent a modified Damus-Kaye-Stans el operation with concomitant aortic arch enlargement. The aortic arch was enlarged in 12 of 13 patients with a pulmonary homograft patch. R esults. There have been no early deaths and only one late death at 39 months postoperatively from hepatoblastoma. The mean follow-up is 42 m onths. There have been no reoperations for recurrent aortic arch obstr uction. All survivors are currently well from a cardiac point of view. ' Conclusions. Concomitant single-stage repair for transposition comp lexes with aortic arch obstruction achieves excellent survival and sho uld be the surgical procedure of choice. (C) 1997 by The Society of Th oracic Surgeons.