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The Journal of Thoracic and Cardiovascular Surgery, Vol 105, 925-933, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
C Planche, A Serraf, JV Comas, F Lacour-Gayet, J Bruniaux and A Touchot
Between September 1, 1982, and March 1, 1992, 40 patients underwent
anatomic repair of transposition of the great arteries, ventricular septal
defect, and aortic arch obstruction. In group I, 26 patients (65%)
underwent repair in a two-stage procedure, phases A and B. Phase A included
repair of the aortic arch obstruction with (16 patients) or without (10
patients) pulmonary artery banding through a left thoracotomy (mean age
18.7 +/- 23.4 days). There were three deaths and three reoperations. Phase
B included an arterial switch operation with closure of the ventricular
septal defect (mean age 95.5 +/- 122 days). There were five early deaths
and two late deaths. Eight patients required reoperation. Mean delay
between phase A and phase B was 77.5 +/- 109 days. In group I, there were
eight early and two late deaths, and 11 patients required reoperation. The
mean stay in the intensive care unit was 24.7 +/- 20 days. Mean follow-up
of 59.6 +/- 21.4 months was completed in all survivors. All but one were in
New York Heart Association class I without medication. Actuarial survival
rate and rate of freedom from reoperation at 5 years were 57.5% and 49.9%,
respectively. In group II, 14 patients (35%) had a one-stage procedure
through midsternotomy: an arterial switch operation with closure of the
ventricular septal defect and repair of the aortic arch obstruction (mean
age 10.2 +/- 5.5 days). There were two early deaths (14.2%) and one late
death after reoperation for overlooked multiple ventricular septal defects.
Two patients required reoperation. The mean stay in the intensive care unit
was 11.7 +/- 2.5 days. Mean follow-up of 22.4 +/- 16.7 months was achieved
in all survivors. They were all in New York Heart Association class I
without medication. Actuarial survival rate and rate of freedom from
reoperation at 3 years were 78.5% and 81.5%, respectively. The one-stage
procedure allowed complete repair in neonates without the need for multiple
operations. We believe that it may decrease early mortality rates (14.2%
versus 30.7%), reduce the reoperation rate and cumulative stay in the
intensive care unit (11.7 days versus 24.7 days, p = Not significant), and
significantly decrease the overall rate of morbidity (p < 0.01).
However, requirements for surgical intervention with a one-stage or a
two-stage procedure must include accurate assessments of intracardiac and
aortic arch anatomy.
ARTICLES
Anatomic repair of transposition of great arteries with ventricular septal defect and aortic arch obstruction. One-stage versus two-stage procedure
Universite Paris Sud, Department of Pediatric Surgery, Marie Lannelongue Hospital, France.
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