Echocardiographic Midterm and Long-term Outcomes After Arterial Switch Operation for d-Transposition of the Great Arteries: A Single-Institution Experience

Abstract

INTRODUCTION: Arterial switch operation is the preferred surgical management for  d-transposition of the great arteries, but it still has long-term complications, which necessitate  continued follow-up of patients. This procedure was first performed in this institution in 1991,  and after three decades, there is a need to evaluate midterm and long-term outcomes in this population.  METHODS: This is a descriptive study on arterial switch operation patients between January  2010 and March 2019 in this institution. The following parameters were collected through review  of charts and online health records (Medtrack): preoperative clinical data, surgical technique  and immediate postoperative course and complications, echocardiographic results, and current  clinical status. The study was approved by the institutional ethics review board of the hospital.  RESULTS: Among the 108 patients included in the study, 35 were long-term patients, and 73  were midterm. A total of 27 patients (25%) were lost to follow-up. Among the remaining patients  (n = 81), 76 (94%) were alive. The most common postoperative complications were pulmonary  stenosis (n = 11), aortic regurgitation (n = 24), and aortic dilatation (n = 2). One patient had  reintervention after surgery for severe pulmonic stenosis. Overall survival function was 93.7%  after 5 years (95% confidence interval, 0.81–0.98) and 79.4% after 9 years (95% confidence  interval, 0.46–0.93).  CONCLUSION: Complications seen in this population are similar to those seen in literature. The  overall survival rate after 5 years compares to those of other institutions. However, long-term  survival rates were lower, which may be due to poor patient follow-up and a high rate of patient  attrition over time. To improve future outcomes, strategies should be implemented to promote  continuity of care, and parents should be advised regarding the importance of follow-up.  KEYWORDS: arterial switch operation, d-TGA, echocardiography, midterm complications, long term complications, survival rate