Anatomic correction of transposition of the great arteries in neonates

Department of Pediatric Cardiac Surgery, Marie Lannelongue Hospital, Le Plessis Robinson, France.

OBJECTIVES. This retrospective study attempts to assess the results of the neonatal anatomic repair of transposition of the great arteries by a single institution. BACKGROUND. Anatomic correction of transposition of the great arteries by means of the arterial switch operation is now widely accepted as the therapeutic method of choice. METHODS. Four hundred thirty-two consecutive neonates underwent an arterial switch operation for various forms of transposition of the great arteries. There were 362 neonates with transposition and intact ventricular septum, 47 with a ventricular septal defect, 6 with intact ventricular septum and coarctation of the aorta and 17 with ventricular septal defect and coarctation. Among patients with coarctation, 18 underwent a single-stage repair through median sternotomy. The mean age was 13.1 +/- 4.2 days. Coronary artery distribution was described according to the origin and initial course of the arteries. RESULTS. Overall in-hospital mortality was 7.8% (34 patients) and was 7.6% for transposition with intact ventricular septum, 8.5% for transposition with ventricular septal defect and 13.3% for transposition with ventricular septal defect and coarctation. Univariate analysis of risk factors revealed that coronary anatomy was the main determinant for operative survival. A mean follow-up time of 44 +/- 19 months was achieved in all but five survivors. More than 95% were in New York Heart Association functional class I, without medication and with normal left ventricular function. Reoperation was performed in 20 patients: early reoperation (< 30 days) in 4 and late reoperation in 16. Actuarial survival rates at 5 years were 91.3% (transposition with intact ventricular septum) and 81.06% (transposition with ventricular septal defect). As well, freedom from reoperation at 5 years was 96.8% (transposition with intact ventricular septum) and 84.6% (transposition with ventricular septal defect). CONCLUSIONS. The arterial switch operation is feasible in almost all forms of transposition of the great arteries in neonates as primary and definitive repair. Palliative surgery is recommended in cases with complex intracardiac anatomy not amenable to early repair.

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