Do Patients with Complete Transposition of the Great Arteries and Severe Pulmonary Hypertension Benefit From an Arterial Switch Operation?
Keywords : -
Background: Whether an arterial switch operation benefits
patients with transposition of the great arteries and se-
vere pulmonary hypertension (PH) remains controversial.
Therefore, we evaluated the relationship between preopera-
tive PH and early and midterm clinical outcomes after an
arterial switch procedure.
Methods
Methods: In this retrospective study, 101 consecutive pa-
tients with transposition of the great arteries underwent an
arterial switch operation between February 2004 and Octo-
ber 2007. Seventy had a ventricular septal defect as well;
patients with intact ventricular septum and complicated con-
comitant abnormities were excluded. Preoperative medical
records were reviewed and mean follow-up was 22.4 ± 15.2
months. After sternotomy, we directly measured pulmonary
artery pressure before and after instituting extracorporeal
circulation. Patients were divided into three groups accord-
ing to mean pulmonary artery pressure (mPAP): control
group (mPAP < 25 mm Hg, n = 23), moderate PH group
(mPAP 25 to 50 mm Hg, n = 37), and severe PH group
(mPAP 50 mm Hg, n = 10). Early and midterm results
were compared among groups.
Results: Postoperatively, pulmonary artery pressure of both
the moderate and severe PH groups decreased significantly.
There were no significant differences in occurrence of post-
operative complications or in-hospital mortality in the three
groups (control group, 8.7%; moderate PH group, 8.1%;
severe PH group, 10%; p = 0.98). However, midterm mor-
tality differed significantly (control group, 4.3%; moderate
PH group, 2.7%; severe PH group, 40%; p < 0.01).
Conclusion
Conclusions: Patients with transposition of the great arter-
ies and mPAP less than 50 mm Hg can achieve satisfying
results after an arterial switch operation. However, even
though the operation can decrease pulmonary artery pres-
sure, patients with preoperative mPAP greater than 50 mm
Hg still suffer from high midterm mortality.
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