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31st Annual Meeting Abstracts: The Arterial Switch Operation for Transposition of the Great Arteries in Europe: A Multi-Institutional Study from the European Congenital Heart Surgeons Association
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P17. The Arterial Switch Operation for Transposition of the Great Arteries in Europe: A Multi-Institutional Study from the European Congenital Heart Surgeons Association
A. C. Chatzis1, N. M. Giannopoulos1, J. Rubay2, C. Panagiotou1, P. Zavaropoulos1, G. Kirvassilis1, G. E. Sarris1. 1Onassis Cardiac Surgery Center, Kallithea, Athens, Greece, 2Clinique Universitaires Saint-Luc, Bruxelles, Belgium,
Background: Arterial switch operation (ASO) became the standard procedure for transposition of the great arteries (TGA) in recent years. This study analyzes the results of the ASO in Europe, in member institutions of the European Congenital Heart Surgeons Association.
Methods: The records of 550 patients (70% male) who underwent ASO for TGA in one of the 17 participating institutions between 1/1998 and 12/2000 were reviewed retrospectively. Ventricular septal defect (VSD) was present in 166 patients (30%), the remaining having intact ventricular septum (IVS). Median age was 10 days (9 for TGA/IVS, 14 for TGA/ VSD, p<0.001) and median weight 3.4 kg. Coronary type was Yacoub type A in 70%, D in 15% and complex in 15% of the patients.
Rashkind septostomy was performed in 399 patients (72%), 345 (62.7%) received prostaglandin, 120 (22%) required preoperative ventilation and 58 (10.7%) inotropic support. At operation median lowest temperature was 22oC and cross-clamp time 85 minutes.
Results: There were 33 hospital deaths (6%), 11 for TGA/IVS (2.9%) and 22 (13%) for TGA/VSD (p<0.001), 76% due to cardiac causes. In 36% of the patients, delayed sternal closure was performed, 7% required peritoneal dialysis and 2% mechanical circulatory support. Median ventilation time was 48 hrs, ICU and hospital stay 5 and 14 days respectively. Multivariate analysis showed the presence of a VSD to be the only independent predictor of hospital death.
Conclusions: Operative mortality for ASO is comparable to reported results while the presence of a VSD was recognized as the sole independent risk factor.
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