Arteriële-switchoperatie bij transpositie van de grote vaten; gunstige resultaten in het Wilhelmina Kinderziekenhuis Utrecht, 1977-2000

To examine the results of the arterial switch operation which is used to correct the transposition of the great arteries.

Design

Descriptive.

Method

In the period May 1977-October 2000 195 patients at the Wilhelmina Children's Hospital in Utrecht, the Netherlands, underwent an arterial switch operation. The patient group consisted of 132 boys and 63 girls, with a median age at surgery of 8 days (range: 0-1976). In accordance with the protocol, the postoperative follow-up consisted of echocardiography and an ECG. Further investigations were performed on indication. Additional data were collected from the status reports. The mean follow-up was 8.0 years (range: 0.04-22.17).

Results

The overall peri-operative mortality was 15 (30/195). Initially this figure was about 50, in the 1980s it was 15 and from 1996 onwards it was 4. Of the 151 surviving and traceable patients, 2 patients died years later (1.3). Of the remaining 149 patients, 145 were classified in New York Heart Association class I and 4 in class II. Due to pulmonary stenosis, 45 reinterventions were required in 26 patients (/149; 17). Left ventricle dysfunction occurred in 5 patients (3), arrhythmias in 5 patients and aorta abnormalities in 5 patients. Coronary artery abnormalities were found in 5 of the 61 patients who underwent angiography (8).

Conclusion

Peri-operative mortality decreased to 4 and late mortality was 1.3. The long-term clinical outcome of the arterial switch operation was good. Morbidity was predominantly caused by pulmonary stenosis and late coronary obstruction.