Abstract 14716: The Arterial Switch Operation for Complex Transposition of the Great Arteries: 20 Years After
The arterial switch operation (ASO) is the procedure of choice for treatment of all forms of transposition of the great arteries (TGA) including complex forms associated with ventricular septal defect with/without aortic arch obstruction. This prospective study evaluates the status of survivors at adult age. Among 688 pts who were operated on at our hospital for complex TGA between 1982 and 2011, 103 had already reached adult age (>18 years). All had a hemodynamically significant ventricular septal defect, 23 had an aortic arch obstruction including coarctation (22 pts), and interrupted aortic arch (1 pt). In 20 pts (19.4%), a 2 stage management was performed after an initial palliative pulmonary artery banding and aortic arch repair when necessary. During a mean follow-up of 19.2 ± 4 years (range:18-27), 2 late deaths occurred (1.94%, 95CL:1.92-2.02), respectively at 5 and 10 months postoperatively, both patients awaiting reoperation for severe aortic valve insufficiency. Actuarial survival was 97.1% at 10, 20 and 25 years. Permanent pacemaker implantation was required in 4 pts. Reoperations were performed in 22 patients (21.4%, 95CL:17%-52%), mainly for pulmonary stenosis (7 pts), aortic valve insufficiency (4 pts) and left ventricular outflow tract obstruction (3 pts). Freedom from reoperation at 10, 20 and 25 years were 90.2%, 76.9% and 65.7%. At last follow-up, all pts were asymptomatic with normal left ventricular function on echocardiography. Aortic root diameters were collected in 52 pts of whom 29 (55.8%) had an aortic root dilatation (>2 SD) which occurred more frequently in those with initial aortic arch obstruction compared to those without (respectively 86.7% vs 43.2% of pts, p=0.0043). Close to 20 years after ASO for complex TGA, late outcome was encouraging with no death after the first year of life. Need for reoperation was not uncommon. Good LV function and sinus rhythm were maintained in almost all pts. However, aortic root may dilate with time, more likely in pts with initial aortic arch obstruction who justify a close follow-up.
- © 2012 by American Heart Association, Inc.