Results over a Ten-Year Period of Palliation followed by Corrective Surgery for Complete Transposition of the Great Arteries

Abstract

One hundred and twenty patients with transposition of the great arteries (TGA) were encountered over a decade. Survivors have been followed until after definitive repair, and 39% were alive when reviewed. The majority (69%) had no significant communication between the pulmonary and systemic circulations. Of 48 patients in this poor-mixing group who had an atrial septectomy, 23 (48%) survived to have an atrial baffle repair at an average age of 37 months, and 37% were alive at the time of review. In contrast, 18 of 22 (82%) patients with poor mixing who had a balloon septostomy had a definitive operation at an average age of 13 months, and 17 (77%) survived. Twenty patients (17%) had good mixing between the two circulations due to the presence of a large ventricular septal defect (VSD) or patent ductus arteriosus, and presented with mild cyanosis and heart failure. Of this group, 35% were alive when reviewed. Four of the five patients who had a successful atrial baffle repair and correction of associated lesions were less than 4 months of age when this was performed. Where TGA was associated with VSD and pulmonary stenosis, 36% survived. Definitive operation at an early age has been made possible by the introduction of a surgical technic using profound surface-induced hypothermia and limited cardiopulmonary bypass.