Factors influencing early and late outcome of the arterial switch operation for transposition of the great arteries

J Thorac Cardiovasc Surg. 1995 Feb;109(2):289-301; discussion 301-2. doi: 10.1016/S0022-5223(95)70391-8.


Between January 1983 and January 1992, 470 patients underwent an arterial switch operation at our institution. An intact (or virtually intact) ventricular septum was present in 278 of 470 (59%); a ventricular septal defect was closed in the remaining 192. Survivals at 1 month and 1, 5, and 8 years among the 470 patients were 93%, 92%, 91%, and 91%, respectively. The hazard function for death (at any time) had a rapidly declining single phase that approached zero by one year after the operation. Risk factors for death included coronary artery patterns with a retropulmonary course of the left coronary artery (two types) and a pattern in which the right coronary artery and left anterior descending arose from the anterior sinus with a posterior course of the circumflex coronary. The only procedural risk factor identified was augmentation of the aortic arch; longer duration of circulatory arrest was also a risk factor for death. Earlier date of operation was a risk factor for death, but only in the case of the senior surgeon. Reinterventions were performed to relieve right ventricular and/or pulmonary artery stenoses alone in 28 patients. The hazard function for reintervention for pulmonary artery or valve stenosis revealed an early phase that peaked at 9 months after the operation and a constant phase for the duration of follow-up. Incremental risk factors for the early phase included multiple ventricular septal defects, the rapid two-stage arterial switch, and a coronary pattern with a single ostium supplying the right coronary and left anterior descending, with a retropulmonary course of the circumflex. The need for reintervention has decreased with time. The arterial switch operation can currently be performed early in life with a low mortality risk (< 5%) and a low incidence of reintervention (< 10%) for supravalvular pulmonary stenosis. The analyses indicate that both the mortality and reintervention risks are lower in patients with less complex anatomy.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Child, Preschool
  • Coronary Vessel Anomalies / mortality
  • Coronary Vessel Anomalies / surgery
  • Heart Arrest, Induced
  • Heart Septal Defects, Ventricular / mortality
  • Heart Septal Defects, Ventricular / surgery
  • Humans
  • Infant
  • Infant, Newborn
  • Linear Models
  • Postoperative Complications / epidemiology
  • Proportional Hazards Models
  • Reoperation / statistics & numerical data
  • Risk Factors
  • Survival Analysis
  • Survival Rate
  • Time Factors
  • Transposition of Great Vessels / mortality*
  • Transposition of Great Vessels / surgery*
  • Treatment Outcome