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George E. Sarris
Andrew C. Chatzis
Mark Hazekamp
Thierry Carrel
Juan V. Comas
Duccio Di Carlo
Willem Daenen
Tjark Ebels
Josè Fragata
Vladimir Ilyin
Harald L. Lindberg
Dominique Metras
Marco Pozzi
Heikki Sairanen
Giovanni Stellin
Andreas Urban
Gerhard Ziemer
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Right arrow Congenital - cyanotic
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J Thorac Cardiovasc Surg 2006;132:633-639
© 2006 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

The arterial switch operation in Europe for transposition of the great arteries: A multi-institutional study from the European Congenital Heart Surgeons Association

George E. Sarris, MDa,*, Andrew C. Chatzis, MDa, Nicolas M. Giannopoulos, MDa, George Kirvassilis, MDa, Hakan Berggren, MDb, Mark Hazekamp, MDc, Thierry Carrel, MDd, Juan V. Comas, MDe, Duccio Di Carlo, MDf, Willem Daenen, MDg, Tjark Ebels, MDh, Josè Fragata, MDi, Victor Hraska, MDj, Vladimir Ilyin, MDk, Harald L. Lindberg, MDl, Dominique Metras, MDm, Marco Pozzi, MDn, Jean Rubay, MDo, Heikki Sairanen, MDp, Giovanni Stellin, MDq, Andreas Urban, MDr, Carin Van Doorn, MDs, Gerhard Ziemer, MDt on behalf of the European Congenital Heart Surgeons Association

a Onassis Cardiac Surgery Center, Athens, Greece
b Children's Heart Center, Queen Silvia's Hospital for Children and Adolescents, Goteborg, Sweden
c the Department of Cardiothoracic Surgery, University Medical Center, Leiden, the Netherlands
d Clinic for Cardiovascular Surgery, University Hospital, Bern, Switzerland
e Pediatric Heart Institute, Hospital Universitario "12 de Octubre," Madrid, Spain
f Ospedale Pediatrico Bambino Gesu, Rome, Italy
g Cardiac Surgery, Gasthuisberg University Hospital, Leuven, Belgium
h Thorax Centre, Groningen University Medical Centre, the Netherlands
i Hospital de Santa Marta, Lisbon, Portugal
j Department of Cardiac Surgery, Children's University Hospital, Bratislava, Slovakia
k Bakulev Center for Cardiovascular Surgery, Moscow, Russia
l Department of Thoracic and Cardiovascular Surgery, University Hospital, Oslo, Norway
m Department of Cardiothoracic Surgery, Hôpital de la Timone, Marseille, France
n Alder Hey Cardiac Unit, Royal Liverpool Children's Hospital, Liverpool, United Kingdom
o Service de Chirurgie Cardivasculaire et Thoracique Université Catholique de Louvain, Clinique Universitaires Saint-Luc, Brussels, Belgium
p Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
q University of Padova, Padova, Italy
r Deutsches Kinderherzzentrum, St Augustin, Germany
s The General Infirmary, Leeds, United Kingdom
t Klinik für Thorax, Herz- und Gefässchirurgie, Eberhard Karls Universitat, Tubingen, Germany

Read at the 31st Annual Meeting of the Western Thoracic Surgical Association, Victoria, British Columbia, Canada, June 22-25, 2005.

Received for publication August 27, 2005; revisions received December 11, 2005; accepted for publication January 19, 2006.

* Address for reprints: George E. Sarris, MD, Onassis Cardiac Surgery Center, 356 Sygrou Ave, Kallithea, Athens, Greece 176 74 (Email: gsarris{at}hol.gr).

OBJECTIVES: This study analyzes the results of the arterial switch operation for transposition of the great arteries in member institutions of the European Congenital Heart Surgeons Association.

METHODS: The records of 613 patients who underwent primary arterial switch operations in each of 19 participating institutions in the period from January 1998 through December 2000 were reviewed retrospectively.

RESULTS: A ventricular septal defect was present in 186 (30%) patients. Coronary anatomy was type A in 69% of the patients, and aortic arch pathology was present in 20% of patients with ventricular septal defect. Rashkind septostomy was performed in 75% of the patients, and 69% received prostaglandin. There were 37 hospital deaths (operative mortality, 6%), 13 (3%) for patients with an intact ventricular septum and 24 (13%) for those with a ventricular septal defect (P < .001). In 36% delayed sternal closure was performed, 8% required peritoneal dialysis, and 2% required mechanical circulatory support. Median ventilation time was 58 hours, and intensive care and hospital stay were 6 and 14 days, respectively. Although of various preoperative risk factors the presence of a ventricular septal defect, arch pathology, and coronary anomalies were univariate predictors of operative mortality, only the presence of a ventricular septal defect approached statistical significance (P = .06) on multivariable analysis. Of various operative parameters, aortic crossclamp time and delayed sternal closure were also univariate predictors; however, only the latter was an independent statistically significant predictor of death.

CONCLUSIONS: Results of the procedure in European centers are compatible with those in the literature. The presence of a ventricular septal defect is the clinically most important preoperative risk factor for operative death, approaching statistical significance on multivariable analysis.

Abbreviations and Acronyms ASO = arterial switch operation; CI = confidence interval; ECHSA = European Congenital Heart Surgeons Association; ECMO = extracorporeal membrane oxygenation; ICU = intensive care unit; IVS = intact ventricular septum; TGA = transposition of the great arteries; VSD = ventricular septal defect




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