| Improvement in long-term survival after hospital discharge but not in freedom from reoperation after the change from atrial to arterial switch for transposition of the great arteries. | |
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MedLine Citation:
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PMID: 19185149 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To compare survival, freedom from reoperation, and functional status between atrial switch and arterial switch operations for transposition of the great arteries. METHODS: Data from 88, 329, and 512 patients who underwent Mustard, Senning, and arterial switch operations between 1974 and 2006 were analyzed. RESULTS: In-hospital mortalities were 8.0% for Mustard, 4.6% for Senning, and 6.4% for arterial switch. Presence of ventricular septal defect (hazard ratio 3.3, P < .001) was the only risk factor for in-hospital mortality in multivariate analysis. Follow-up for Mustard was 22.6 +/- 8.1 years, for Senning was 18.2 +/- 5.7 years, and for arterial switch was 9.5 +/- 5.7 years. Highest survival at 20 years was after arterial switch (96.6% +/- 1.3%), followed by Senning (92.6% +/- 1.5%) and Mustard (82.4% +/- 4.3%). Transposition with ventricular septal defect (hazard ratio 3.1, P < .001), transposition with ventricular septal defect and left ventricular outflow tract obstruction (hazard ratio 3.0, P = .029), and Mustard operation (hazard ratio 2.1, P = .011) emerged as risk factors for late death, with arterial switch a protective factor (hazard ratio 0.3, P = .010). Highest freedom from reoperation at 20 years was after Senning (88.7% +/- 1.9%), followed by arterial switch (75.0% +/- 6.4%) and Mustard (70.6% +/- 5.4%). Presence of complex transposition (hazard ratio 2.1, P < .001), previous palliative operation (hazard ratio 1.8, P = .016), surgery between 1985 and 1995 (hazard ratio 2.6, P = .002), surgery after 1995 (hazard ratio 3.5, P < .001), and Mustard operation (hazard ratio 3.3, P < .001) emerged as risk factors for reoperation. CONCLUSION: Change from atrial to arterial switch led to improved long-term survival after hospital discharge but not to lower incidence of reoperation. Survival and freedom from reoperation are determined by morphology. |
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Authors:
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Jürgen Hörer; Christian Schreiber; Julie Cleuziou; Manfred Vogt; Zsolt Prodan; Raymonde Busch; Klaus Holper; Rüdiger Lange |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The Journal of thoracic and cardiovascular surgery Volume: 137 ISSN: 1097-685X ISO Abbreviation: J. Thorac. Cardiovasc. Surg. Publication Date: 2009 Feb |
Date Detail:
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Created Date: 2009-02-02 Completed Date: 2009-02-19 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0376343 Medline TA: J Thorac Cardiovasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 347-54 Citation Subset: AIM; IM |
Affiliation:
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Department of Cardiovascular Surgery, German Heart Center Munich, Technical University Munich, Munich, Germany. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Cardiac Surgical Procedures
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methods*,
mortality* Heart Septal Defects, Ventricular / complications Humans Reoperation / statistics & numerical data Retrospective Studies Risk Factors Transposition of Great Vessels / complications, mortality*, surgery* Ventricular Outflow Obstruction / complications |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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