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The Journal of Thoracic and Cardiovascular Surgery, Vol 103, 421-427, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
FM Lupinetti, EL Bove, LL Minich, AR Snider, LB Callow, JN Meliones, DC Crowley, RH Beekman, G Serwer and M Dick 2d
An assessment of late morbidity and mortality is essential before arterial
repair can be considered truly corrective for patients with transposition
of the great arteries. We describe the early and intermediate-term results
in 126 patients who underwent arterial repair. Operation was performed at a
median age of 6 days, with 76 patients operated on within the first 7 days
of life. Coronary artery anatomy differed from the usual arrangement in 37
patients. Simultaneous procedures included ventricular septal defect
closure (35) and repair of interrupted aortic arch (2) or coarctation (5).
Hospital mortality was seven of 126 (5.5%), with three deaths among the
most recent 100 patients (3%). There were one late, noncardiac death and
one late death after reoperation. Reoperation for pulmonary artery stenosis
was required in 10 of the first 63 patients (16%), all of whom underwent
pulmonary artery reconstruction with separate patches for closure of the
coronary excision sites. Of the last 63 patients, all of whom underwent
pulmonary artery reconstruction with a single pantaloon- shaped pericardial
patch, one (2%) required reoperation for pulmonary artery stenosis. Doppler
flow studies and echocardiography performed in 115 of 119 surviving
patients at a mean of 12 months after repair demonstrated normal left
ventricular function, minimal left ventricular outflow gradients, and no
more than trivial aortic regurgitation. Peak gradient across the right
ventricular outflow tract was 19 +/- 3 mm Hg in patients with separate
pulmonary artery patches and 5 +/- 2 mm Hg in those with a single pantaloon
patch (p = 0.0001). Follow-up is 96% complete from 1 month to 8 years after
operation (mean 2.5 years). The actuarial survival rate at 5 years,
including operative mortality, was 92%. All patients are in sinus rhythm,
and none requires antiarrhythmic medications. These data suggest that
pulmonary artery reconstruction with a single pantaloon patch may be
associated with a decreased requirement for reoperation. Intermediate-term
survival and functional results are excellent after arterial repair for
transposition of the great arteries.
ARTICLES
Intermediate-term survival and functional results after arterial repair for transposition of the great arteries
Department of Surgery, University of Michigan School of Medicine, Ann Arbor.
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