Late outcome after arterial switch operation for transposition of the great arteries

Background-Early and midterm results of the arterial switch operation (ASO) in transposition of the great arteries (TGA) are good, but late outcome da ta in large populations are still few. Methods and Results-Twelve hundred patients had an ASO for TGA between 1982 and 1999, with prospective follow-up of 1095 survivors. Outcome measures i ncluded late death, reoperation, aortic insufficiency (AI), pulmonary steno sis (PS), and coronary anomaly. Median follow-up was 4.9 years (range 0.5 t o 17 years). Late death occurred in 32 patients, survival was 88% at both 1 0 and 15 years. The hazard function for death declined rapidly, with no dea ths after 5 years. Late mortality was correlated with reintervention and ma jor events in the intensive care unit. Reoperation was performed in 103 pat ients, more often in complex TGA; the cause was mainly PS. Freedom from rei ntervention was 82% at 10 and 15 years, with a hazard function that decline d rapidly but slowly increased after 3 years. At the last follow-up, PS was present in 3.9% of patients, and grade II or more Al was present in 3.2%. with a cumulative incidence of 9% at 15 years. Among the 278 patients who h ad a coronary arteriography, 8% had coronary lesions. Normal left ventricle and sinus rhythm were seen in 96.4% and 98.1%, respectively. Conclusions-Fifteen years after ASO, late mortality was low, with no deaths after 5 years; reoperation. mainly owing to PS, occurred throughout the fo llow-up. Al and coronary obstruction are rare but warrant further follow-up . Good left ventricular function and sinus rhythm are maintained.