Circulation, Vol 86, 1501-1515, Copyright © 1992 by American Heart Association
JW Kirklin, EH Blackstone, CI Tchervenkov and AR Castaneda
BACKGROUND. As the probability increases that the arterial switch operation
is optimal treatment for transposition, detailed information about outcomes
and the circumstances in which they are suboptimal becomes important.
METHODS AND RESULTS. A multi-institutional prospective study with annual
detailed follow-up included 513 neonates with simple transposition or
transposition and ventricular septal defect entering for diagnosis and
treatment at < 15 days of age and undergoing an arterial switch repair.
The 1-month and 1- and 5-year survivals were 84%, 82%, and 82%,
respectively. The hazard function for death had a rapidly declining single
phase that approached zero by 12 months after surgery. Among the eight
patients who died > or = 3 months after the operation, four had severe
ventricular dysfunction, probably related to imperfect coronary arterial
transfer. Coexisting single ventricular septal defect was not a risk factor
for death. Origin of the left main coronary artery or only the left
anterior descending or the circumflex artery from the right posterior sinus
(sinus 2) was a risk factor that was even stronger when an intramural
course was present; multiplicity of ventricular septal defects was a risk
factor. Longer global myocardial ischemic time and total circulatory arrest
time were risk factors. Certain institutions were shown to be risk factors
for death; the results in some improved with increasing experience, in some
they did not, and in some they worsened. CONCLUSIONS. Good early and
intermediate-term clinical outcomes can be obtained in neonates with simple
transposition and transposition and ventricular septal defect by use of the
arterial switch operation. Certain coronary artery patterns and certain
institutions lessen the goodness of outcome.
ARTICLES
Clinical outcomes after the arterial switch operation for transposition. Patient, support, procedural, and institutional risk factors. Congenital Heart Surgeons Society
Division of Cardiothoracic Surgery, University of Alabama, Birmingham Medical Center 35294.
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