TRANSPOSITION OF THE GREAT ARTERIES: OPERATIVE OUTCOME AND MEDIUM TERM FOLLOW-UP
J. Armishaw*, T.L. Gentles, A.L. Calder, P.J. Raudkivi, A.R. Kerr.
Departments of paediatric Cardiology and Cardiothoracic Surgery, Green Lane Hospital, Auckland, New Zealand.
Aim: To assess the operative outcome and cardiac and neurodevelopmental sequelae in infants with transposition of the great arteries (TGA) undergoing the arterial switch procedure (ASO).
Methods: A retrospective analysis was undertaken to review surgical outcomes in infants who underwent the ASO for definitive repair of TGA and double outlet right ventricle at Green Lane Hospital between 1984 and 1997. Cross-sectional review of the subgroup operated on in the calendar years 1996 and 1996 was then undertaken to obtain recent cardiac, growth and neurodevelopmental parameters.
Results: Operative mortality fell from 27% in the first 3 years of experience to 3% in the last 3 years. Between January 1995 and December 1996, 48 patients underwent the ASO. In this subgroup there was one operative death, and one death secondary to pulmonary vascular disease at 15 months of age. The medium term survival after surgery was therefore 96% at a mean follow-up interval of 17 months. Six (13%) have important residual cardiac lesions; supra valvular pulmonary stenosis is the most common. Growth parameters at follow-up are normal, as is the neurodevelopmental progress of all but two survivors, both of whom had pre-operative risk factors for subsequent neurological abnormality.
Conclusions: In the current era the ASO is a relatively safe procedure with excellent cardiac and neurodevelopmental outcome in the majority of infants. Of our cohort 96% are alive and 88% are free from death, reintervention and significant neurological sequelae at a mean follow-up of 17 months.
