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

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.