Original article: cardiovascularArterial switch operation: factors impacting survival in the current era☆
Section snippets
Material and methods
Between September 1986 and December 1999, 201 patients who had the ASO performed by two surgeons were included in this review. Informed consent and institutional approvals were obtained for this study. The operative experience is divided into two periods separated by the technique of coronary artery placement into the neoaorta. In phase 1 (1986 to 1989), reimplantation of coronary button into open sinuses was done before neoaortic reconstruction. In phase 2 (1989 to 1999), reimplantation of the
Results
Overall, early mortality for the entire study period was 19 of 201 (9.5%). Mortality for phase 1 was 8 of 29 (27.6%) and reflected our learning curve for complex coronary patterns and other complex anatomy. The coronary reimplantation technique changed in phase 2 and the mortality fell to 11 of 172 (6.4%) (p = 0.002) (Table 3). The early mortality for TGA-VSD was, as expected, higher than for TGA-IVS (13.1% vs 7.6%) for the entire series but lower for Taussig-Bing DORV (9.1%). These differences
Comment
A review of the literature and the retrospective analysis of our data demonstrate a progressive decrease in mortality over time for the ASO 10, 11, 12, 13, 14, 15, 16. The low incidence of late complications as compared with the atrial switch (Mustard and Senning) procedure is well documented and does not require further discussion 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18. The early mortality of ASO of 4.8% for TGA-IVS and the 10.0% mortality for TGA-VSD in phase 2 of our
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