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Predictors of post-operative mortality in patients with d-transposition of great arteries who underwent arterial switch operation.


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      Transposition of great arteries is a congenital heart disease characterized by atrio-ventricular concordance and ventriculo-arterial discordance. It represents 5-7% all congenital heart diseases, corresponding to an incidence of 20 to 30 per 100,000 live births. There is a male predominance with a male/female sex ratio that varies, in the literature, from 1.5:1 to 3.2:1.1

        Until mid twentienth century, the treatment of transposition was restricted to few palliative measures and the natural history of the disease with its poor prognosis was an undeniable reality having an average life expectancy for a newborn with transposition of 0.65 years, and the mortality rate at one year was 89.3.1 With the advent of newer and improved surgical techniques as well as post-operative intensive care, the current scenario has evolved, and encouraging long term- survival of about 90% at 15 years of age have been reported.2

      After the introduction of arterial switch operation (ASO) by Jatene and colleagues in 1975, as techniques in myocardial preservation improved and experience in coronary and congenital cardiac surgery accumulated, it evolved into the primary modality for treating transposition of the great arteries (TGA) by and large replacing the Mustard and Senning operation.3 It has evolved from a pioneering neonatal procedure to a reproducible technique allowing anatomic repair of transposition of the great arteries (TGA) and selected forms of double-outlet right ventricle (DORV)4.

     The post-operative outcome after an arterial switch operation relies on several factors which include pre-operative management, surgical technique, cardiopulmonary bypass procedure and post-operative intensive care. Most of al, proper patient selection is deemed necessary in order to achieve a good and favorable post-operative outcome.



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Philippine Heart Center Medical Library PHC.R.001.14 Fulltext Print Format

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