Recent experience with the arterial switch operation in transposition of the great arteries

Objective: Review of our experience with the technically demanding arterial switch operation in transposition of the great arteries in children. Methods: Twenty-seven children who underwent an arterial switch operation i n our clinic were retrospectively reviewed. Except for one child (operated on at eight months), the operation was performed during the neonatal period . The underlying pathology was d-transposition of the great arteries in 25 children and a double outlet right ventricle of transposition type in 2. Fi ve children had an associated ventricular septum defect and 1 aortic isthmu s coarctation. The pattern of the coronary arteries was favourable in 18 ch ildren, difficult in 7 and dangerous in 3. The operation was performed in c ardiopulmonary bypass for repair of the transposition and in a period of de ep hypothermic circulatory arrest for repair of the intracardiac defects. Results: One child died perioperatively and 1 postoperatively (operative mo rtality 7%) from myocardial ischaemia following unsuccessful transfer of a dangerous pattern of coronary arteries. Another child, a low-birth weight b aby, died 80 days after the operation from respiratory failure. Postoperati ve morbidity occurred in 10 patients and medium-term morbidity in 6 patient s who presented various degrees of stenosis of a pulmonary artery. During a median follow-up of 18 months no patient required reoperation. The childre n are asymptomatic and thriving satisfactorily. Conclusion: Because it restores the heart physiology, the arterial switch o peration is considered the procedure of choice for correction of transposit ion of the great arteries. The operation involves acceptable mortality and morbidity. Transfer of difficult coronary artery patterns and development o f stenosis on the pulmonary arteries remain problematic.