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The Journal of Thoracic and Cardiovascular Surgery, Vol 96, 854-863, Copyright © 1988 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
WI Norwood, AR Dobell, MD Freed, JW Kirklin and EH Blackstone
A total of 466 neonates with transposition of the great arteries, all less
than 15 days of age, have been entered into a 20-institution study between
Jan. 1, 1985, and June 1, 1987. Seventy-three percent were less than 48
hours old when entered into the study. Two hundred twelve of these
underwent an arterial switch repair, and the 1-week, 1-year, and 2 1/2-year
survival rates were 82%, 79%, and 78%, respectively. The usual coronary
anatomy was present in 67% of the patients. The arterial switch repair was
performed in 16 of the institutions. Six among these were shown to be
"low-risk" institutions, with the prevalence of the demographic and
surgical variables seeming to be the same in these as in the other
institutions. The 1-week, 1-year, and 2 1/2-year survival rates after the
arterial switch repair in low-risk institutions for simple transposition
were 96%, 91%, and 90%, respectively; for transposition with ventricular
septal defect they were 84%, 83%, and 83%. Only older age at operation
(over 14 days of age), in the case of simple transposition, and
transposition with ventricular septal defect were risk factors for death in
these six institutions. Among the patients as a whole, freedom from
reoperation for pulmonary outflow obstruction at 1 week and 1 year was 99%
and 89%, respectively. A previous pulmonary artery banding and, possibly,
one institution were identified as risk factors for reoperation.
Inferences: In low-risk institutions, the arterial switch repair can be
accomplished with good early results, which suggests the possibility that
the late results will be better than after the atrial switch repair. Since
young age was not a risk factor for the arterial switch repair of
transposition and ventricular septal defect, this type of repair for this
anomaly, as well as for simple transposition, may be more advantageously
performed early in life than at 2 to 3 months of age.
ARTICLES
Intermediate results of the arterial switch repair. A 20-institution study
Children's Hospital of Philadelphia, PA.
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