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Two-Stage Arterial Switch Operation: is Late Ever Too Late?

Department of Cardiac Surgery Prince Sultan Cardiac Centre Riyadh Military Hospital Riyadh, Saudi Arabia
For reprint information contact: Khawar Aizaz, FRCSI Tel: 966 1 467 9353 Fax: 966 1 467 1581 email: kzazs{at}yahoo.com Department of Cardiac Surgery (F-277), Prince Sultan Cardiac Centre, Riyadh Military Hospital, P.O. Box 7897, Riyadh 11159, Saudi Arabia.

Results of the two-stage arterial switch operation in 49 patients with transposition of the great arteries, performed between January 1995 and September 2000, were reviewed retrospectively. Twenty-one patients had a ventricular septal defect. Anatomical correction was carried out 21.89 ± 9.86 months after pulmonary artery banding, with or without a modified Blalock-Taussig shunt. Hospital mortality was 8% (4 patients). During follow-up of 30.12 ± 14.38 months, there was 1 late death and 1 patient required reoperation for pseudoaneurysm of the ascending aorta. Actuarial survival and freedom from reoperation at 5 years were 90% and 97%, respectively. Late anatomic correction (> 6 months) after the preliminary procedure can be performed with an acceptable mortality and morbidity, but undue delay may lead to left ventricular dysfunction, arrhythmias, and new aortic valve regurgitation or subaortic stenosis.

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