Transposition of the great arteries associated with ventricular septal defect: surgical results and long-term outcome

Objectives: To identify potential risk factors influencing early and late o utcome following the arterial switch operation (ASO) for transposition of t he great arteries associated with ventricular septal defect including doubl e-outlet right or left ventricle. Methods: All patients who underwent ASO i n our department until August 2000 (n = 105) were included in this study. T here were 77 transpositions of the great arteries with ventricular septal d efect. 22 Taussig-Bing hearts and six patients with double-outlet morpholog y. The median age at operation was 24 days. Aortic arch obstruction was pre sent in 25 patients: in 13 of these patients, a repair with aortic arch rec onstruction was done before ASO. The usual coronary artery pattern was pres ent in 59% of the patients. In six patients, we found an intramural course of at least one coronary artery. The ventricular septal defect was closed w ith a patch through the right atrium (n = 35), the aorta (n = 25), the pulm onary artery (n = 25) or the right ventricle (n = 3); in 17 patients a comb ined approach was necessary. Results: There were five hospital deaths (4.7% , 95% confidence limit 2-11%). The median duration of follow-up was 72 mont hs. Fourteen patients underwent 15 reoperations 33 months after repair (med ian), eight for right ventricular outflow tract obstruction or neopulmonary stenosis. Four late deaths occurred, two due to complications related to c oronary artery anomalies. Statistical analysis revealed no significant risk factor whatsoever correlating with death or need for reoperation. Survival after 12 years was 91.6%, and freedom from reoperation was 82.6%, Latest f ollow-up data showed that 13% of patients were in NYHA class II and/or requ ired medical treatment; 87% were in NYHA class I. Conclusions: ASO associat ed with patch closure of ventricular septal defect can be per-formed early in life with a low risk of mortality (<5%), low incidence of reintervention (< 15%) and promising long-term outcome. (C) 2001 Published by Elsevier Sc ience B.V.