Surgical results of arterial switch operation for XXXX : is position of the great arteries a risk factor?

@entity1 @entity204 @entity1147 @entity1757
BACKGROUND: A variety of definitive operations have been used to manage @entity1 with @entity1147 right ventricle and subpulmonary @entity1757 ( @entity1147 ). This study identifies the impact of the position of the great arteries and use of a staged surgical approach on the outcome after the arterial switch operation in @entity1 with @entity1147 . METHODS: From 1986 through July 2005, 34 @entity1 with @entity1147 underwent the arterial switch operation. The median age at operation was 21 days. Based on position of the great arteries, @entity1 were divided into group I (side by side; n = 16) and group II (anteroposterior; n = 18). Aortic arch obstruction was present in 18 @entity1 (53%), of whom 16 had prior repair with aortic arch reconstruction. Abnormal coronary artery patterns were present in 9 @entity1 (27%). RESULTS: There were 4 early deaths and 1 late @entity204 (3 from group I and 2 from group II). The actuarial survival rate was 85% at 15 years (81% in group I and 89% in group II). Right ventricular outflow tract obstruction (mean gradient, 46.0 +/- 5.5 mm Hg) developed in 5 cases (2 from group I and 3 from group II). One @entity1 underwent reoperation for residual aortic arch obstruction. Freedom from reoperation was 80% at 15 years, and thereafter 85% in group I and 75% in group II. Statistical analysis of potential risk factors revealed no significant identifiers for @entity204 or need for reoperation between groups. CONCLUSIONS: The arterial switch operation remains our preferred choice of treatment for @entity1 with @entity1147 . The position of the great arteries has no effect on postoperative morbidity and mortality. In the presence of aortic arch obstruction, staged arch reconstruction followed soon thereafter by early intracardiac repair has yielded excellent outcomes in our experience.
