Transposition of the great arteries: single center experiences

Abstract

Objectives: Transposition of great arteries is the most common cyanotic congenital heart disease. It is characterized by ventriculoarterial discordance and atrioventricular concordance. The aim of the present study was to review the anatomical and embryological basis of this anomaly and to discuss the surgical outcomes of arterial switch operations. Methods: The study included a total of 61 patients who underwent arterial switch operation. Demographic, anatomical, operative data, duration of stay in intensive care unit, need of postoperative extra corporeal membrane oxigenator, need of delayed sternal closure and mortality rate were retrieved from the institutional databases and medical records. Results: The median age of the patients was 22.9±61.26 (1–455) days, and their weights ranged between 3391.97±686.6 (1900–5500) grams. Transposition of great arteries accompanied intact ventricular septum in 39 patients (63.9%) and ventricular septal defect in 22 patients (36.1%). Coronary arteries were abnormal in 11 patients (18%). Mortality was observed in 7 patients (11.5%) and was seen 5.71±2.98 (1–10) days after surgery. The incidence of coronary anomaly in patients with mortality was 28.6%. The most common coronary anomaly in patients with coronary anomaly with mortality is the anomaly in which the circumflex artery originates from the right coronary artery. Conclusion: Arterial switch operations provide anatomical and complete correction in transposition of great arteries. It can be performed with appropriate timing, good preoperative, peroperative and postoperative management with low mortality. Coronary artery anomaly is not a contraindication for arterial switch operations, and with the detailed and careful evaluation of the appropriate coronary artery anatomy, transpositions with coronary anomalies are often uneventful.