Arterial switch operation: factors impacting survival in the current era

Ann Thorac Surg. 2001 Jun;71(6):1978-84. doi: 10.1016/s0003-4975(01)02529-2.


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.

MeSH terms

  • Actuarial Analysis
  • Adolescent
  • Child
  • Child, Preschool
  • Double Outlet Right Ventricle / mortality
  • Double Outlet Right Ventricle / surgery*
  • Female
  • Follow-Up Studies
  • Heart Septal Defects, Ventricular / mortality
  • Heart Septal Defects, Ventricular / surgery
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Postoperative Complications / mortality*
  • Retrospective Studies
  • Survival Rate
  • Transposition of Great Vessels / surgery*