IS THE ARTERIAL SWITCH OPERATION STILL A CHALLENGE IN SMALL CENTERS

Objective: In the last years, major changes as regards timing for oper ation, surgical technique, and perioperative care determined a great i mprovement in the arterial switch operation (ASO) allowing excellent m id-term results in a few leading centers. This stimulated the widespre ad adoption of ASO as procedure of choice for transposition of the gre at arteries (TGA), even in small institutions. We reviewed our early e xperience with ASO in an attempt to evaluate Its safety in a small cen ter. Methods: Since April 1991, 39 consecutive patients underwent TGA repair by ASO in our department There were 27 patients with simple TGA , 8 with TGA and VSD and 4 with Taussig-Bing heart and aortic coarctat ion. Median age and weight at operation were 7 days and 3.5 kg, respec tively. Neonatal repair was performed in 34 patients. In accordance wi th the Planche coronary classification, type I was encountered in 21 p atients, type II in 4 and type III in 14. Several modifications of the original technique were used, mainly regarding coronary relocation, p ulmonary artery reconstruction and approaches for associated VSD closu re and aortic arch repair. Results: Early mortality was 2.6% (n = 1), the only operative death being related to unsatisfactory coronary relo cation. Since modified ultrafiltration was adopted, mean ICU slay decr eased from 5 +/- 4 days (n = 21) to 2 +/- 1 days (n = 17) (P < 0.05). Three patients required reoperation for residual ASD and/or VSD closur e. There M-ere no late deaths, After a mean follow-up of 26 +/- 15 mon ths all survivors are thriving and are currently asymptomatic, Conclus ions: Although this series is rather small, most of the major coronary anomalies and complex anatomic associations were: encountered. This e xperience suggests that neonatal repair of TGA by ASO call be safely a ccomplished even in small centers. Modified ultrafiltration appears to improve the early outcome of neonates undergoing ASO. (C) 1997 Elsevi er Science B.V.