Anatomical correction of complex forms of transposition of the great arteries in neonates

Objective - The arterial switch operation has become the procedure of choice for the simple transposition of the great arteries (TGA) while in the complex forms of the defect the staged approach is frequently implemented. The aim of this study is to compare groups of patients with simple transposition and children with the complex form of the defect and identify factors affecting early and late outcome. Design - From 1997 to 2003, 135 consecutive neonates with TGA underwent arterial switch operation and simultaneous reparation of all associated defects. Univariate and multivariate analysis of perioperative variables and follow-up data was performed. Patients were divided into two groups. Group I (n = 84, 62.2%) included neonates with simple transposition ( TGA/ IVS), Group II ( n = 51, 37.8%) included children with complex transposition (TGA/VSD). Results - Overall early mortality was 8.1% and there was one late death (0.7%). One-month, 1-year and 5-year actuarial survival rates were 91.8, 91.1 and 91.1%, respectively. There were no differences in the early and late survival rate between groups. Reintervention rate for right ventricular outflow tract obstruction (RVOTO) was 13.3% ( balloon plasty or reoperation). The freedom from reintervention at 1, 3 and 5 years was 98.4, 87.9 and 85.4%, respectively. There were no differences in the need for reintervention between groups. The significant differences between groups concerned: age at operation ( p < 0.001), associated anomalies ( p = 0.002) including aortic arch anomalies ( p = 0.002) and coronary artery anomalies ( p = 0.02), application of delayed chest closure ( p = 0.015), and occurrence of sepsis ( p = 0.032). Risk factors for early death were: left ventricule dysfunction related to age at operation ( p = 0.016) and resternotomy in intensive care unit ( p < 0.001). There were no differences between groups concerning these risk factors as far as circulatory arrest time, aorta clamping time, and early and late morbidity. Conclusions - The arterial switch operation can be the treatment of choice for various forms of TGA with low early and late mortality and morbidity rates. The main cause of early death is still left ventricular dysfunction. Such well-known predictors of poor outcome as presence of ventricular septal defect, coronary artery anomalies and aortic arch anomalies did not affect early and late findings. The presented approach of early simultaneous anatomical correction of TGA and all associated anomalies ensures good condition of children with low necessity for reintervention.