Outcomes of the arterial switch for transposition during infancy using a standardised approach over 30 years

Nigel E Drury, Shafi Mussa, John Stickley, Oliver Stumper, Adrian Crucean, Rami Dhillon, Anna N Seale, Phil Botha, Natasha E Khan, David J Barron, William J Brawn, Timothy J Jones, Ashish Chikermane, Chetan Mehta, Michael Harris

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Abstract

OBJECTIVES
To describe the early and late outcomes of the arterial switch for transposition.

METHODS
A single-centre retrospective cohort study was conducted to assess the early and late outcomes of arterial switch performed during infancy using a standardised institutional approach between 1988 and 2018, compared by morphological groups.

RESULTS
749 consecutive patients undergoing arterial switch during infancy were included, 464 (61.9%) with intact septum, 163 (21.8%) with isolated ventricular septal defect, and 122 (16.3%) with complex transposition with associated lesions, including 67 (8.9%) with Taussig-Bing anomaly. There were 34 early deaths (4.5%, 95% CI 3.1–6.1) with only 10 (2.6%) early deaths since 2000. Complex morphology (OR 11.44, CI 4.76–27.43) and intramural coronary artery (OR 5.17, CI 1.61–15.91) were identified as the most important risk factors for 90-day mortality. Overall survival was 92.7% (95% CI 90.8–94.6) at 5 years and 91.9% (95% CI 89.9–94.1) at 20 years; in hospital survivors, there were 15 (2.1%) late deaths during a median follow-up of 13.7 years. Cumulative incidence of surgical or catheter reintervention was 16.0% (95% CI 14.5–17.5) at 5 years and 22.7% (95% CI 21.0–24.0) at 20 years; early and late reinterventions were more common in the complex group, with no difference between the other groups.

CONCLUSIONS
Using a standardised approach, the arterial switch can be performed with low early mortality, moderate rates of reintervention, and excellent long-term survival. Concomitant lesions were the most important risk factor for early death and were associated with increased risk of late reintervention.
Original languageEnglish
Article numberivad070
Number of pages9
JournalInterdisciplinary CardioVascular and Thoracic Surgery
Volume36
Issue number7
Early online date10 May 2023
DOIs
Publication statusE-pub ahead of print - 10 May 2023

Keywords

  • Transposition
  • Arterial switch
  • Survival
  • Reintervention

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