Thirty-year experience with the arterial switch operation

Ann Thorac Surg. 2011 Sep;92(3):973-9. doi: 10.1016/j.athoracsur.2011.04.086.


Background: We evaluated the results of the arterial switch operation (ASO) being performed at our institution for more than 30 years and identified risk factors for mortality and reoperation.

Methods: Clinical outcome of 332 consecutive patients with transposition of the great arteries undergoing ASO was retrospectively analyzed, using surgical reports, medical charts, and latest follow-up echocardiography. Statistical analysis was performed using the Kaplan-Meier method and univariable and multivariable binary logistic and Cox regression analyses.

Results: In-hospital mortality was 11.4%. At 15 years, estimated overall survival was 85.2%, and estimated freedom from reoperation was 74.0%. Cross-clamp time (p=0.001) and absence of the Lecompte maneuver (p=0.001) were identified as independent risk factors for in-hospital mortality, whereas coronary problems during surgery (p=0.009) and postoperative pacemaker implantation (p<0.001) were independent risk factors for late mortality. Independent risk factors for reoperation were higher age at the time of the ASO (p=0.002), presence of arch abnormalities (p<0.001), coronary problems during surgery (p=0.005), and duration of ventilation (p<0.001). At latest echocardiography, moderate or severe neoaortic regurgitation was present in 3.4% of the patients.

Conclusions: Overall, 30 years of experience with the ASO shows good survival and event-free survival rates. Coronary transfer problems during surgery were found to be an important risk factor for late mortality and reoperation. However, coronary anatomy other than 1LCx-2R and an intramural course of the left coronary artery or left anterior descending artery were not risk factors for mortality or reoperation. Neoaortic regurgitation does not seem to form a major problem.

Publication types

  • Comparative Study

MeSH terms

  • Cardiac Surgical Procedures / methods*
  • Cardiac Surgical Procedures / mortality
  • Child
  • Child, Preschool
  • Disease-Free Survival
  • Echocardiography
  • Female
  • Follow-Up Studies
  • Hospital Mortality / trends
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Kaplan-Meier Estimate
  • Male
  • Netherlands / epidemiology
  • Postoperative Complications / epidemiology
  • Proportional Hazards Models
  • Reoperation / statistics & numerical data
  • Retrospective Studies
  • Risk Factors
  • Transposition of Great Vessels / diagnostic imaging
  • Transposition of Great Vessels / mortality
  • Transposition of Great Vessels / surgery*
  • Treatment Outcome