Long-term survival and functional follow-up in patients after the arterialswitch operation

Background. For many years, the arterial switch operation (ASO) has been th e therapy of choice for patients with transposition of the great arteries ( TGA). Although excellent short- and mid-term results were reported, long-te rm results are rare. Methods. Between May 1983 and September 1997, ASO was performed on 285 pati ents with simple TGA (n = 171), TGA with ventricular septal defect (VSD) (n = 85), and Taussig-Bing (TB) anomaly (n = 29). This retrospective study de scribes long-term morbidity and mortality over a 15-year period. Results. Hospital mortality was 3.5% for simple TGA, 9.4% for TGA with VSD, and 13.8% for TB anomaly. Late death occured in 2 patients, 1 with simple TGA and 1 with TGA and VSD. The cumulative survival for all patients at 5 a nd 10 years is 93%, and at 15 years is 86%. Reoperations were required in 3 1 patients and were most common for stenosis of the right ventricular outfl ow tract (RVOT). However, no correlation was found between technical variat ions on pulmonary artery reconstruction and this type of complication. Fort y-six patients underwent follow-up angiography, which revealed five cases w ith coronary occlusion or stenosis. Follow-up is complete in 96% of the pat ients from 1 to 15.2 years. Sinus rhythm is present in 97%; 88% of the pati ents show no limitations on exertion. Conclusions. The ASO can be performed with low early mortality, almost abse nt late mortality, and infrequent need for reoperation. The favorable long- term results demonstrate that the ASO can be considered as the optimal appr oach for patients with TGA and special forms of double-outlet right ventric le. (C) 1999 by The Society of Thoracic Surgeons.