Long-term outcomes after the arterial switch operation for D-transposition of the great arteries – a single centre experience

Abstract

Background: Arterial switch operation (ASO) is the treatment of choice for D-transposition of great arteries (D-TGA). The purpose of the study was to evaluate the long-term outcome after ASO. Methods: We either retrospectively reviewed the documentation or reassessed 38 patients (30 men, 8 women) during the transition period from adolescence to adulthood (age at the last clinical examination 17.1 ± 1.4 years) born from 2000 until 2005 with D-TGA and performed early ASO. We assessed: NYHA functional class, residual changes in neoaorta and neoaortic valve, neopulmonary valve, and pulmonary arteries, right and left ventricular function, physical performance, and signs of myocardial ischaemia. Results: There was no mortality confidence interval (0.00-0.09). Thirty-two patients (84.2%) were in NYHA class I, and 6 patients (15.7%) were in NYHA class II. In 83.3% of patients, the aortic root was dilated (20.9 ± 2.8 mm/m2, max. 27.7 mm/ m2). Neoaortic valve regurgitation was present in 27 patients (90%). There were no differences in bulbus width normalized to body surface area between groups without, mild or moderate neoaortic regurgitation (p = 0.6). Neopulmonary valve regurgitation was present in 58.1%. Due to an obstruction in the right ventricular outflow at any level, reoperation was required in one case and percutaneous dilatation of the neopulmonary valve in 1 case. Due to coronary artery complications, surgery was required only in one case because of myocardial infarction during exertion. Conclusion: Late results after complete correction in patients with D-TGA are good and comparable to larger centres. There was no mortality; most patients were asymptomatic, with normal systolic function of both ventricles and normal physical performance. Reoperations and percutaneous procedures were quite rare and successful in the long run.