Late Outcome After Arterial Switch Operation for Transposition of the Great Arteries

Background: Early and midterm results of the arterial
switch operation (ASO) in transposition of the great arteries (TGA)
are good, but late outcome data in large populations are still few.


Methods and Results: Twelve hundred patients had an
ASO for TGA between 1982 and 1999, with prospective follow-up of
1095 survivors. Outcome measures included late death, reoperation,
aortic insufficiency (AI), pulmonary stenosis (PS), and coronary
anomaly. Median follow-up was 4.9 years (range 0.5 to 17 years).
Late death occurred in 32 patients; survival was 88% at both 10 and
15 years. The hazard function for death declined rapidly, with no
deaths after 5 years. Late mortality was correlated with
reintervention and major events in the intensive care unit.
Reoperation was performed in 103 patients, more often in complex
TGA; the cause was mainly PS. Freedom from reintervention was 82% at
10 and 15 years, with a hazard function that declined rapidly but
slowly increased after 3 years. At the last follow-up, PS was
present in 3.9% of patients, and grade II or more AI was present in
3.2%, with a cumulative incidence of 9% at 15 years. Among the 278
patients who had a coronary arteriography, 8% had coronary lesions.
Normal left ventricle and sinus rhythm were seen in 96.4% and 98.1%,
respectively.

Conclusions: Fifteen years after ASO,
late mortality was low, with no deaths after 5 years; reoperation,
mainly owing to PS, occurred throughout the follow-up. AI and
coronary obstruction are rare but warrant further follow-up. Good
left ventricular function and sinus rhythm are maintained.

From Centre Chirurgical Marie-Lannelongue, Le Plessis-Robinson, France.

Correspondence to Dr Losay, Centre Chirurgical Marie-Lannelongue, 133 Avenue de la Résistance, 92350 Le Plessis-Robinson, France. E-mail [email protected]