ABSTRACT
OBJECTIVE: To examine the results of the arterial switch operation which is used to correct the transposition of the great arteries. DESIGN: Descriptive. METHOD: In the period May 1977-October 2000 195 patients at the Wilhelmina Children's Hospital in Utrecht, the Netherlands, underwent an arterial switch operation. The patient group consisted of 132 boys and 63 girls, with a median age at surgery of 8 days (range: 0-1976). In accordance with the protocol, the postoperative follow-up consisted of echocardiography and an ECG. Further investigations were performed on indication. Additional data were collected from the status reports. The mean follow-up was 8.0 years (range: 0.04-22.17). RESULTS: The overall peri-operative mortality was 15% (30/195). Initially this figure was about 50%, in the 1980s it was 15% and from 1996 onwards it was 4%. Of the 151 surviving and traceable patients, 2 patients died years later (1.3%). Of the remaining 149 patients, 145 were classified in New York Heart Association class I and 4 in class II. Due to pulmonary stenosis, 45 reinterventions were required in 26 patients (/149; 17%). Left ventricle dysfunction occurred in 5 patients (3%), arrhythmias in 5 patients and aorta abnormalities in 5 patients. Coronary artery abnormalities were found in 5 of the 61 patients who underwent angiography (8%). CONCLUSION: Peri-operative mortality decreased to 4% and late mortality was 1.3%. The long-term clinical outcome of the arterial switch operation was good. Morbidity was predominantly caused by pulmonary stenosis and late coronary obstruction.