Arterial switch operation: Factors impacting survival in the current era

Background. The arterial switch procedure has become the preferred procedur e for the transposition of the great arteries (TGA) and Taussig-Bing anomal y. This analysis is intended to identify potential factors affecting surviv al in the current era. Methods. From 1986 to 1999, 201 consecutive patients underwent an arterial switch operation for TGA or Taussig-Bing anomaly. Multivariate analysis of perioperative variables was performed for operative morbidity/mortality. Pa tients were separated into two groups. Phase 1 (n = 29) included patients b efore mid-1989 who underwent an open coronary reimplantation technique. Pha se 2 (n = 172) included the patients undergoing a technique of reimplanting coronary buttons after neoaortic reconstruction. Results. The patient population included TGA with intact ventricular septum (58.7%, 118 of 201), with ventricular septal defect (31.3%, 61 of 201), an d Taussig-Bing anomaly (10.0%, 22 of 201). Overall, early mortality was 9.5 % (19 of 201) and there were five late deaths (2.7%). One-month, 1-year, an d 5-year actuarial survival rates were 90.4%, 87.9%, and 87.9%, respectivel y. Reoperation rate for late pulmonary stenosis was 2.7% (5 of 182). The fr eedom from reoperation at 3 and 5 years was 97.5% and 93.3%, respectively. In the analysis by time period, the operative mortality declined from 27.6% (8 of 29) to 6.4% (11 of 172) (p = 0.002). Risk factors for operative deat h were coronary artery patterns (usual vs retropulmonary left coronary arte ry, p = 0.009) in phase 1 and preoperative instability in phase 2 (p = 0.00 2). Conclusions. The arterial switch operation for TGA and Taussig-Bing anomaly has early low and late mortality and reoperation rates. Technical modifica tions in coronary reimplantation have minimized coronary artery pattern-rel ated risks. (C) 2001 by The Society of Thoracic Surgeons.