Author + information
After its introduction by Jatene and colleagues in 1975, the arterial switch operation (ASO) has become the surgical technique of choice for correction of transposition of the great arteries (TGA) with or without ventricular septal defect (VSD). Short- and mid-term results are promising, but data on long-term outcome are limited and major complications may occur.
Our work is intended to assess the long term results of ASO in Tunisian children with TGA and to identify potential factors affecting these results.
We studied 44 patients with ASO (mean age: 11.5 years, 73%-male, 50 % TGA with VSD) followed at our department. The inclusion criterion was at least 5 years of follow-up. Complete clinical examination, standard and 24-hour Holter electrocardiogram, M-mode, 2D-and color Doppler echocardiography and coronary investigations were performed.
Mean follow-up was 106 months (8.83 years). One patient died (2.27%). Impaired left ventricular function was observed in 5 cases (11.36%). Right ventricular outflow tract obstruction was observed in 6 patients (13.63%) requiring reintervention in 2 cases. Pulmonary regurgitation was frequent (40.90%). Aortic regurgitation was observed in 20 patients (45.45%) but appeared not to be progressive. Coronary lesions were found in 4 patients (9.09%) requiring a coronary artery bypass graft (CABG) in 1 case. Intramural coronary artery course was the risk factor of late coronary arteries lesions (p=0.013) Freedom from late reintervention was 84% at 15 years after ASO. Eight late reinterventions were performed in 4 patients (9.09%) with a mean age of 10.43 years.
The TGA, including complex types, can be corrected with good long-term outcomes by ASO. The association to a VSD was not considered to be a predictor of long-term complications except of aortic regurgitation. Right ventricular outflow tract dysfunction was the main reason for late reinterventions. Potential risk of myocardial ischemia requires regular appropriate follow up.