Outcomes of Patients After Arterial Switch Operation: 18 Years of Experience in a Single Medium-Volume Center.

Abstract

The objective of this paper was to describe the outcomes in patients submitted to arterial switch operation and to analyze the predictors of in-hospital mortality and further need of re-operation at a single-center institution. Between September 1995 and January 2014, 128 consecutive arterial switch operations were performed. Surgical mortality during this period was analyzed retrospectively, and a follow-up analysis of the survivors was conducted. Surgical era, cardiopulmonary bypass time (p = 0.001), and diagnosis category (p = 0.025) influenced in-hospital mortality. The estimated overall survival for the 91 hospital survivors was 96.8, 96.4, and 96.2 % at 5, 10, and 15 years, respectively. The median follow-up time was 67 months (range 0.71-222 months). Three patients (5 %) presented severe aortic regurgitation. Right ventricle outflow tract systolic gradient by echocardiography was above 60 mmHg in 2 %. Late re-interventions occurred in 12 (13 %) patients with mean time of 64 ± 34 months after the initial procedure. Actuarial freedom from re-interventions at 5, 10, and 15 years was 96.4, 69.7, and 61.9 %, respectively. Arterial switch operation remains the procedure of choice in patients with transposition of great arteries. It can be performed even in middle-volume institutions, leading to the same middle- and long-term outcomes of high-volume institutions. Early high mortality rate may occur due not only to learning curve, but also to cardiopulmonary bypass time and ventricular septal defect closure.

• Authors: Paulo H Manso, Fernando T V Amaral, Tarcísio J S Júnior, Mauro C Jurca, Jorge Haddad, Walter V A Vicente, Ricardo N Sgarbieri, Fabio Carmona
• Journal: Pediatric cardiology (Pediatr Cardiol) Vol. 36 Issue 8 Pg. 1657-61 (Dec 2015) ISSN: 1432-1971 [Electronic] United States
• PMID: 26036352 (Publication Type: Journal Article)

Topics

• Aortic Valve Insufficiency (surgery)
• Arterial Switch Operation (statistics & numerical data)
• Brazil
• Child
• Child, Preschool
• Echocardiography
• Female
• Follow-Up Studies
• Heart Septal Defects, Ventricular (surgery)
• Hospital Mortality
• Humans
• Infant
• Infant, Newborn
• Kaplan-Meier Estimate
• Male
• Postoperative Complications (diagnosis)
• Reoperation (mortality)
• Retrospective Studies
• Transposition of Great Vessels (mortality, surgery)