The arterial switch operation in Europe for transposition of the great arteries: A multi-institutional study from the European Congenital Heart Surgeons Association

Sarris, George E.;Chatzis, Andrew C.;Giannopoulos, Nicolas M.;Kirvassilis, George;Ziemer, Gerhard;et.al.
(2006) The Journal of Thoracic and Cardiovascular Surgery — Vol. 132, n° 3, p. 633-639 (2006)

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Authors
  • Sarris, George E.
    Author
  • Chatzis, Andrew C.
    Author
  • Giannopoulos, Nicolas M.
    Author
  • Kirvassilis, George
    Author
  • Rubay, JeanUCLouvain
    Author
  • Sairanen, HeikkiUCLouvain
    Author
  • Ziemer, Gerhard
    Author
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Abstract
Objectives: This study analyzes the results of the arterial switch operation for transposition of the great arteries in member institutions of the European Congenital Heart Surgeons Association. Methods: The records of 613 patients who underwent primary arterial switch operations in each of 19 participating institutions in the period from January 1998 through December 2000 were reviewed retrospectively. Results: A ventricular septal defect was present in 186 (30%) patients. Coronary anatomy was type A in 69% of the patients, and aortic arch pathology was present in 20% of patients with ventricular septal defect. Rashkind septostomy was performed in 75% of the patients, and 69% received prostaglandin. There were 37 hospital deaths (operative mortality, 6%), 13 (3%) for patients with an intact ventricular septum and 24 (13%) for those with a ventricular septal defect (P < .001). In 36% delayed sternal closure was performed, 8% required peritoneal dialysis, and 2% required mechanical circulatory support. Median ventilation time was 58 hours, and intensive care and hospital stay were 6 and 14 days, respectively. Although of various preoperative risk factors the presence of a ventricular septal defect, arch pathology, and coronary anomalies were univariate predictors of operative mortality, only the presence of a ventricular septal defect approached statistical significance (P = .06) on multivariable analysis. Of various operative parameters, aortic crossclamp time and delayed sternal closure were also univariate predictors; however, only the latter was an independent statistically significant predictor of death. Conclusions: Results of the procedure in European centers are compatible with those in the literature. The presence of a ventricular septal defect is the clinically most important preoperative risk factor for operative death, approaching statistical significance on multivariable analysis.
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Sarris, G. E., Chatzis, A. C., Giannopoulos, N. M., Kirvassilis, G., Berggren, H., Hazekamp, M., Carrel, T., Comas, J. V., Di Carlo, D., Daenen, W., Ebels, T., Fragata, J., Hraska, V., Ilyin, V., Lindberg, H. L., Metras, D., Pozzi, M., Rubay, J., Sairanen, H., et al. (2006). The arterial switch operation in Europe for transposition of the great arteries: A multi-institutional study from the European Congenital Heart Surgeons Association. The Journal of Thoracic and Cardiovascular Surgery, 132(3), 633-639. https://doi.org/10.1016/j.jtcvs.2006.01.065 (Original work published 2006)