doiSerbia

Midterm results after complete surgical correction of transposition of the great arteries

Parezanović Vojislav (School of Medicine, Belgrade + University Children’s Hospital, Belgrade)
Mrđen Mirko (General Hospital, Loznica)
Ilić Slobodan (School of Medicine, Belgrade + University Children’s Hospital, Belgrade)
Vulićević Irena (University Children’s Hospital, Belgrade)
Đukić Milan (School of Medicine, Belgrade + University Children’s Hospital, Belgrade)
Jovanović Ida (School of Medicine, Belgrade + University Children’s Hospital, Belgrade)
Stefanović Igor (University Children’s Hospital, Belgrade)
Ilisić Tamara (University Children’s Hospital, Belgrade)
Kalanj Jasna (University Children’s Hospital, Belgrade)
Mimić Branko (University Children’s Hospital, Belgrade)
Milovanović Vladimir (University Children’s Hospital, Belgrade)

Introduction. Arterial switch operation (ASO) is a cardiosurgical method of choice for complete anatomical correction of transposition of great arteries. Improvement of this procedure has made considerably improved the outcome and long-term prognosis of children born with this complex congenital heart disease. Objective. The aim of this study was to estimate the success rate of ASO through retrospective analysis of mortality and late complications. Methods. This study included 57 children operated from 1st January 2005 until 31st December 2009. Parameters that could influence the outcome of surgery were investigated. The following late complications were investigated: neopulmonary artery stenosis, neoaortic stenosis and regurgitation, as well as clinical signs of heart failure. Results. Early postoperative mortality was 15.8% (9/57 patients). During follow-up (8 to 72 months, average 36.5 months) there were no lethal outcomes. On the last echocardiography examination, 73.2% patients had neoaortic regurgitation and 67.4% patients had neopulmonary regurgitation, but all of them were mild in intensity. Neopulmonary stenosis had 32.6% of patients, but only two had moderate or severe stenosis. No one had ischemic ECG changes. Three reinterventions were performed due to serious residual problems: surgical correction of neoaortic stenosis, surgical correction of neopulmonary stenosis and transcatether balloon dilatation for aortic recoarctation. At the end of the follow-up period, only one of 46 consistently followed patients had signs of heart failure which required therapy (2.2%), while the majority of patients were without any symptoms and with good effort tolerance. Conclusion. Arterial switch operation has been successfully performed at our institution, with acceptable perioperative mortality and excellent late outcome.

Keywords: transposition of the great arteries, arterial switch operation, children