Primary Arterial Switch Operation Treatment For Complete Transposition Of The Great Arteries

Objective: To summarize the clinical experience of complete transposition of the great arteries (TGA) treatment with primary arterial switch operation (ASO) in 9 patients.Method: Nine patients with TGA were repaired by primary ASO from August 2003 to December 2008, includes 8 males and 1 female; 6 patients were diagnosis as TGA/IVS, operative age was 11-45 (25.83±14.59) d,weight was 2.8-4.5 (3.42±0.73) kg; and 3 TGA/VSD with operative age was 13-109 (54±49.37) d, weight was 2.5-5.0 (3.83±1.26) kg. Preoperative SPO2 was 70-88%. All patients were diagnosed by echocardiography before operations; pulmonary pressure was measured in one patient and figured out PP/PS: 0.80. ASO was proceeding under general anesthesia and DHLF, 4 patients with DHCA. New main pulmonary artery was reconstructed with"prolonged anastomosis"method. All operative data was collected, and compared the CPB time, aortic cross-clamp time, ventilator time and post operation hospital time with 1710 patients with open-heart surgery at the corresponding period.Result:The CPB time was 220.78±68.36 min, aortic cross-clamp time was 122.00±24.52 min. DHCA time of 4 patients was 8-17min. Ventilator time was 209.64±128.59 h. Intensive care time was 13.57±4.61 d, post operation hospital time ASO was 24.00±12.19 d. 2 patients were found coronary anatomy in operations. One patient was diagnosis CoA after ASO, treatment with the operation. One minor PS and one mild AR were found though echocardiography after operations in different patients. There were 3 hospital deaths. Delayed sternal closure was performed in 3 patients. 6 patients were followed up 1 to 4 years. The echocardiography of all patients showed good heart function. Compared with the 1710 patients, ASO patients had significant longer CPB time (p= 0.000), aortic cross-clamp time (p= 0.000), ventilator time (p= 0.007) and post operation hospital time (p= 0.033).Conclusion:The primary ASO is the prime operative method treatment of TGA, which was complex operation with longer recover after operation than ordinarily open-heart surgery. Preoperative precisely diagnosis through echocardiography was contributed to get effective management to patients. Preoperative management strategies such as appropriate dose PGE1 used and on time BSA make patients with TGA/IVS approach ASO. The situation of left ventricular function decided operative method; properly arranged coronary artery buttons was the key to ASO results. Miniaturization of CPB appliance and suitable management guaranteed the success of ASO. The suitable section position of the great arteries decreased the risk of PS after ASO, long-term follow-up required further refinement.