Extending the boundaries of the primary arterial switch operation in patients with transposition of the great arteries and intact ventricular septum.

Abstract:

BACKGROUND:We have previously suggested that the primary arterial switch operation is a feasible strategy for patients with transposition of the great arteries and intact ventricular septum (TGA-IVS) up to age 2 months. This study reports our current results with this approach and examines whether this policy could be extended beyond age 2 months. METHODS AND RESULTS:380 patients who underwent arterial switch for TGA-IVS were reviewed. 275 patients were younger than 3 weeks at the time of surgery (early switch group); 105 patients were 3 weeks or older (range, 21 to 185 days) (late switch group). There was no difference in outcome in terms of in-hospital mortality (5.5% versus 3.8%) or need for mechanical circulatory support (3.6% versus 5.7%) between early and late switch groups. However, duration of postoperative ventilation (4.9 versus 7.1 days, P=0.012) and length of postoperative stay (12.5 versus 18.9 days, P<0.001) were significantly prolonged in the late switch group. Primary left ventricular failure resulting in death occurred in 2 patients in the late switch group, with no deaths in 9 patients aged 2 to 6 months. CONCLUSIONS:This experience confirms that in TGA-IVS, the left ventricle maintains the potential for systemic work well beyond the first month of life. Consequently, neonates at high risk or late referrals can benefit from delayed arterial switch, even beyond age 2 months. However, the need for mechanical support in some of the older patients may limit the widespread adoption of such a strategy.

journal_name

Circulation

journal_title

Circulation

authors

Kang N,de Leval MR,Elliott M,Tsang V,Kocyildirim E,Sehic I,Foran J,Sullivan I

doi

10.1161/01.CIR.0000138221.68312.33

subject

Has Abstract

pub_date

2004-09-14 00:00:00

pages

II123-7

issue

11 Suppl 1

eissn

0009-7322

issn

1524-4539

pii

110/11_suppl_1/II-123

journal_volume

110

pub_type

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