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(Circulation. 2004;110:II-123 – II-127.)
© 2004 American Heart Association, Inc.

Surgery for Congenital Heart Disease

Extending the Boundaries of the Primary Arterial Switch Operation in Patients With Transposition of the Great Arteries and Intact Ventricular Septum

Nicholas Kang, FRACS; Marc R. de Leval, MD FRCS; Martin Elliott, MD FRCS; Victor Tsang, MS MSc, FRCS; Ergin Kocyildirim, MD; Igor Sehic, MD; John Foran, FRCP; Ian Sullivan, FRACP

From the Great Ormond Street Hospital for Children National Health Service Trust, London, UK.

Correspondence to Professor Marc R. de Leval, Cardiothoracic Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK. E-mail delevm{at}gosh.nhs.uk

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.

Key Words: transposition of great vessels • heart defects • congenital • surgery