Long-Term Survival After Arterial Versus Atrial Switch in d-Transposition of the Great Arteries.

Document Type

Article

Publication Date

12-2018

Identifier

DOI: 10.1016/j.athoracsur.2018.06.084; PMCID: PMC6240478

Abstract

BACKGROUND: The arterial switch operation (ASO) became the procedure of choice for dextro-transposition of the great arteries (d-TGA) nearly 30 years ago, but the long-term results of this operation are unknown. We aimed to compare the long-term transplant-free survival of patients with d-TGA who underwent ASO versus atrial switch in the Pediatric Cardiac Care Consortium.

METHODS: We performed a retrospective cohort study of d-TGA patients undergoing ASO or atrial switch in the United States between 1982 and 1991. Long-term transplant-free survival was obtained by linking Pediatric Cardiac Care Consortium data with the National Death Index and the Organ Procurement and Transplant Network. Kaplan-Meier survival plots were constructed, and multivariable regression was used to compare long-term transplant-free survival.

RESULTS: Of 554 d-TGA patients who underwent ASO (n = 259) or atrial switch (n = 295), the 20-year overall transplant-free survival was 82.1% for those undergoing ASO and 76.3% for those who had atrial switch procedure. Adjusted overall transplant-free survival beyond 10 years after operation was superior for ASO compared with atrial switch (hazard ratio 0.07, 95% confidence interval: 0.01 to 0.52, p = 0.009). During this period, the ASO had higher in-hospital mortality than the atrial switch (21.6% versus 12.9%, p = 0.007). After excluding patients with in-hospital mortality, the transplant-free survival 20 years after repair was 97.7% for the ASO patients versus 86.3% for the atrial switch patients.

CONCLUSIONS: Despite initial higher in-hospital mortality for ASO during the study period, there is a significant long-term transplant-free survival advantage for ASO as compared with atrial switch for d-TGA surgery. Ongoing monitoring is required to assess late risk of cardiovascular disease.

Journal Title

The Annals of thoracic surgery

Volume

106

Issue

6

First Page

1827

Last Page

1833

MeSH Keywords

Arterial Switch Operation; Cohort Studies; Female; Hospital Mortality; Humans; Infant; Infant, Newborn; Male; Retrospective Studies; Survival Rate; Time Factors; Transposition of Great Vessels

Keywords

Arterial Switch Operation; Cohort Studies; Female; Hospital Mortality; Humans; Infant; Infant, Newborn; Male; Retrospective Studies; Survival Rate; Time Factors; Transposition of Great Vessels

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