Extended follow-up after atrial repair for transposition of the great arteries: A younger age at surgery improves late survival

Background: Surgical treatment for transposition of the great arteries (TGA ) usually involves anatomic repair, although atrial repair is used in cases with special coronary artery patterns. Methods: Records of all 239 patient s surviving at least 30 days after atrial correction of TGA between 1962 an d 1987 at the University Hospital in Zurich were reviewed. The mean length of follow-up time was 13.7 years (median 14.9 years; range from 0.05 to 30. 1 years). The average age at surgery was 45.7 months (range from 7 days to 24.4 years). One hundred twenty-one patients had a simple TGA, whereas the remaining 118 had a complex TGA. Results: The surviving patients were in NY HA class I at time of follow-up. The most common reasons for death were sys temic right ventricular dysfunction and sudden rhythm disturbances. There w as a major risk for late cardiac event in patients over 3 years old at oper ation (p = 0.02) and also in patients with complex TGA (p = 0.03). However, date of surgery, previous surgery, or the postoperative requirement for a pacemaker did not greatly affect late cardiac mortality. Conclusions: Altho ugh the procedure of choice for TGA is the arterial switch operation, the p romising findings of the current long-term study, which reports the longest follow-up to date, indicate that the atrial switch operation is a good alt ernative procedure for the rare cases where the use of arterial switch proc edures is limited.