Abstract 1802: Preoperative Echocardiographic Variables Are Associated With Death After Arterial Switch Operation for D-Transposition and Aortic Arch Obstruction
Background Mortality for the arterial switch operation (ASO) for D-transposition of the great arteries (D-TGA) is low, but D-TGA, VSD and aortic arch obstruction (AAO) is a higher risk subgroup. We hypothesized that specific anatomic features would be associated with excess mortality.
Methods Patients undergoing ASO at Children’s Hospital, Boston, 1983–2005, with D-TGA, VSD (or TGA-like DORV) and AAO were identified. Echocardiograms for 79 of 87 eligible patients were reviewed by a single blinded cardiologist (MLS). STATA was used for statistical comparison of survivors (S) with non-survivors (NonS).
Results Patient groups did not differ in baseline clinical characteristics. In univariate analysis, mean distal transverse arch z score (TrAo) was smaller (−2.98±0.58 vs. −2.37±1.17, p = 0.015) in NonS than S. Patients with small TrAo (z ≤ −2.5) had odds of death 4.6 times that of patients with TrAo Z >2.5 (20.5 vs. 5.3% mortality, CI [0.9,23.5], p=0.064). Patients with a small TV (z<0) had an odds of death 7.7 times that of patients with TV z ≥0 (30.4 vs. 5.4% mortality, CI [1.8,33.4], p = 0.005). Mortality rate with neither a small TrAo nor a small TV was 0%; with small TrAo alone, 11.1%; with small TV alone, 18.1%. With both small TV and TrAo, mortality rate was 41.7% (p = 0.003, figure⇓).
Conclusions Preoperative echocardiographic variables were highly associated with death following ASO for D-TGA, VSD and AAO. Small TrAo and TV were individually associated with increased mortality, and in combination, with a more than additive increase in mortality. Distal TrAo and TV sizes can be easily measured on routine preoperative echocardiograms and can assist with prediction of operative risk.