Midterm results appear favorable, although identified complications include aortic insufficiency, pulmonary stenosis, and obstructive coronary disease. 9 The ASO allows the morphological left ventricle to remain systemic and avoids multiple atrial incisions and suture lines that predispose to arrhythmias. The so-called Lecompte maneuver may be performed to place the main pulmonary artery bifurcation anterior to the ascending aorta. It involves translocating the pulmonary artery and aorta above their sinuses and reimplanting the ostia of the coronary arteries in the neoaorta. In the mid 1970s, Jatene developed the arterial switch operation (ASO), 8 which soon after supplanted atrial redirection as the preferred surgical option for D-TGA without pulmonary stenosis. 4 However, recognized long-term complications include systemic right ventricular dysfunction, brady- and tachyarrhythmias, baffle obstructions and shunts, and sudden death. 1 Intra-atrial baffle repair, as pioneered by Senning 2 and Mustard, 3 radically altered the otherwise grim associated prognosis, allowing most patients with D-TGA to thrive well into adulthood. At least moderate neoaortic and pulmonary regurgitation were present in 3.4% and 6.6%, respectively, and more than mild neoaortic and pulmonary stenosis in 3.2% and 10.3%.ĭ-looped transposition of the great arteries (D-TGA) accounts for 5% to 7% of congenital heart defects. Peak oxygen uptake was 35.1☗.6 mL/kg/min (86.1☑5.1% predicted), with a chronotropic index <80% in 34.2%. At last follow-up, the left ventricular ejection fraction was 60.3☘.9%, 97.3% had class I symptoms, and 5.2% obstructive coronary artery disease. Independent predictors were a single right coronary artery (hazard ratio, 4.58 95% confidence interval, 1.32-15.90), P=0.0166) and postoperative heart failure (hazard ratio, 6.93 95% confidence interval, 1.57-30.62 P=0.0107). Freedom from an adverse cardiovascular event was 92.9☑.9% at 25 years.
#112 OPERATOR SWITCH FREE#
At 25 years, 75.5☒.5% remained free from surgical or catheter-based reintervention. Late mortality was predominantly a result of sudden deaths and myocardial infarction. In perioperative survivors, overall and arrhythmia-free survival rates at 25 years were 96.7☑.8% and 96.6☐.1%, respectively. Overall, 400 patients, 154 (38.3%) with a ventricular septal defect, 238 (59.5%) with an intact septum, and 9 (2.3%) with a Taussig-Bing anomaly, were followed for a median of 18.7 years. Patients without follow-up visits within 3 years were contacted and secondary sources of information obtained. Customer Service and Ordering InformationĪ single-institution retrospective cohort study was conducted to assess cardiovascular outcomes after an arterial switch operation between 19.Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).
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