Document Detail


Arterial switch operation: factors impacting survival in the current era.
MedLine Citation:
PMID:  11426778     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The arterial switch procedure has become the preferred procedure for the transposition of the great arteries (TGA) and Taussig-Bing anomaly. This analysis is intended to identify potential factors affecting survival in the current era. METHODS: From 1986 to 1999, 201 consecutive patients underwent an arterial switch operation for TGA or Taussig-Bing anomaly. Multivariate analysis of perioperative variables was performed for operative morbidity/ mortality. Patients were separated into two groups. Phase 1 (n = 29) included patients before mid-1989 who underwent an open coronary reimplantation technique. Phase 2 (n = 172) included the patients undergoing a technique of reimplanting coronary buttons after neoaortic reconstruction. RESULTS: The patient population included TGA with intact ventricular septum (58.7%, 118 of 201), with ventricular septal defect (31.3%, 61 of 201), and Taussig-Bing anomaly (10.0%, 22 of 201). Overall, early mortality was 9.5% (19 of 201) and there were five late deaths (2.7%). One-month, 1-year, and 5-year actuarial survival rates were 90.4%, 87.9%, and 87.9%, respectively. Reoperation rate for late pulmonary stenosis was 2.7% (5 of 182). The freedom from reoperation at 3 and 5 years was 97.5% and 93.3%, respectively. In the analysis by time period, the operative mortality declined from 27.6% (8 of 29) to 6.4% (11 of 172) (p = 0.002). Risk factors for operative death were coronary artery patterns (usual vs retropulmonary left coronary artery, p = 0.009) in phase 1 and preoperative instability in phase 2 (p = 0.002). CONCLUSIONS: The arterial switch operation for TGA and Taussig-Bing anomaly has early low and late mortality and reoperation rates. Technical modifications in coronary reimplantation have minimized coronary artery pattern-related risks.
Authors:
J W Brown; H J Park; M W Turrentine
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  71     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2001 Jun 
Date Detail:
Created Date:  2001-06-27     Completed Date:  2001-07-12     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1978-84     Citation Subset:  AIM; IM    
Affiliation:
Section of Cardiothoracic Surgery, Riley Hospital for Children, and Indiana University School of Medicine, Indianapolis 46202, USA. jobrown@iupui.edu
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MeSH Terms
Descriptor/Qualifier:
Actuarial Analysis
Adolescent
Child
Child, Preschool
Double Outlet Right Ventricle / mortality,  surgery*
Female
Follow-Up Studies
Heart Septal Defects, Ventricular / mortality,  surgery
Humans
Infant
Infant, Newborn
Male
Postoperative Complications / mortality*
Retrospective Studies
Survival Rate
Transposition of Great Vessels / surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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