Long-term outcomes after an arterial switch operation for simple complete transposition of the great arteries

Abstract

Background and objectives: Although coronary artery obstruction, aortic insufficiency (AI), and pulmonary stenosis (PS) have been reported after arterial switch operation (ASO), limited long-term studies on ASO exist. Our study aimed to examine long-term outcomes after ASO for simple complete transposition of the great arteries (TGA).

Subjects and methods: All 108 patients with simple complete TGA who underwent ASO at Seoul National University Children's Hospital between 1987 and 2004 were enrolled. We retrospectively reviewed the patients' medical records and the results of various functional and imaging studies.

Results: Among 108 cases of ASO for simple TGA, 96 have been followed-up through the present time (mean follow-up duration was 11.7+/-8.6 years: range= 4 to 23 years). The 20-year rates of freedom from significant AI, PS, and coronary obstruction were 78.6%, 67.8%, and 95.8%, respectively. AI showed a tendency to progress as follow-up time increased in 21.4% of the population studied (p=0.014); however, AS, PS, and PI showed no such progression. Late coronary artery occlusion was not associated with the initial coronary arterial pattern. Re-operations were done for 13 patients (13.5%) at an average of 8+/-4.3 years after ASO. The survival rate was 96%, while the re-operation-free was 90% at 10 years and 83% at 20 years. Most patients showed normal physical growth with good activity {98%; New York Heart Association (NYHA) class 1 activity} and normal development (96%).

Conclusion: Although most patients showed normal physical growth and development after successful ASO, meticulous long-term follow-up is necessary because of progressive AI and coronary complications.

Keywords: Aortic valve insufficiency; Coronary arteries; Outcomes assessment, patient; Stenosis, pulmonary; Transposition of great vessels.

Fig. 1

The progression of aortic insufficiency (A) and pulmonary insufficiency (B) after arterial switch operation. Aortic insufficiency (AI) tended to progress during the follow-up period (p=0.014), while pulmonary insufficiency (PI) did not progress significantly during follow-up (p=0.189). Both columns show the number of patients with various levels of AI or PI corresponding to the follow-up period.

Fig. 2

The progression of aortic stenosis (A) and pulmonary stenosis (B) after arterial switch operation. Aortic stenosis (AS) and pulmonary stenosis (PS) did not progress significantly during the follow-up period (p=0.687, 0.168 respectively). Both columes show the number of patients with various levels of AS or PS corresponding to the follow-up period.

Fig. 3

Twenty-year follow-up results considering aortic insufficiency (AI) and pulmonary stenosis (PS) after arterial switch operation. The 20-year rates of freedom from significant AI (A) and PS (B) were 78.6% and 67.8%, respectively.

Fig. 4

Survival and re-operation-free rates after arterial switch operation. The survival rate was 96% at 20 years, and the re-operation-free rate was 96%, 90%, 87%, and 83%, respectively, at 5, 10, 15, and 20 years post-operative.

Fig. 5

Growth status (A) and body mass index (B) of patients who underwent arterial switch operation. Patients' growth status and body mass index (BMI) were described 11.3±4.9 years after the arterial switch operation. Most patients (98.8%) demonstrated no delayed growth. A BMI of more than 25, signifying obesity, was observed in 6 patients (7.5%), a prevalence similar to that of the general pediatric population.