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The Journal of Thoracic and Cardiovascular Surgery, Vol 100, 261-269, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
M Yamaguchi, Y Hosokawa, Y Imai, H Kurosawa, H Yasui, T Yagihara, F Okamoto and N Wakaki
A total of 267 infants and children who underwent the arterial switch
operation for transposition of the great arteries in the 6 years before
Jan. 1, 1988 in six main Japanese institutions were entered into this
review. The current status of patients surviving more than 1 year after the
operation were evaluated along with early operative results. One hundred
forty-six patients had an intact ventricular septum, 103 had a significant
ventricular septal defect, and 18 had so-called Taussig- Bing anomaly of
the transposition type. Eighteen patients were less than 28 days of age, 73
were 1 to 5 months of age, and 176 were older than 6 months of age at the
time of operation. The overall mortality rate was 35% in the first 3 years
and 12% in the more recent 3 years. There was a significant difference
between the overall mortality rate of primary and two-stage repair (22%
versus 10%, p = 0.047) in patients with intact ventricular septum. The
overall mortality rate in patients with type B or C coronary arteries of
Yacoub, and Radley-Smith's classification was significantly higher than
that of other types of arteries (86% versus 18%, p = 0.0001). A total of
156 patients survived more than 1 year after the operation, and 44 children
(28%) were noted to have supravalvular pulmonary stenosis (greater than 20
mm Hg). This complication was more common in patients operated on in the
newborn period. Trivial or mild aortic regurgitation was noted in 29
patients (19%) and was more common in patients with two-stage than with
primary repair (24% versus 14%). Aortic regurgitation was significantly
more prevalent in patients in whom coronary arteries were implanted into
slits or U-shaped defects than in those whose arteries were implanted into
punched-out holes made on the pulmonary root (28% versus 8%, p = 0.049).
Normal sinus rhythm was present in 97% of 154 patients and left ventricular
ejection fraction was within the normal range in 97% of 115 patients at
catheterization 1 to 5 months after the operation.
ARTICLES
Early and midterm results of the arterial switch operation for transposition of the great arteries in Japan
Department of Thoracic and Cardiovascular Surgery, Kobe Children's Hospital, Japan.
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