Search

Objective: The arterial switch operation was introduced in 1976 to correct transposition of the great arteries and has since replaced atrial palliation. This study examines the long-term outcomes of the arterial switch operation. Methods: Included in the study were 195 patients who underwent the arterial switch operation from 1977 through June 2000. Patients were evaluated for functional class, pulmonary stenosis, left ventricular function, arrhythmias, aortic sequelae, and coronary disease. Results: Overall perioperative mortality was 15%, but rates dropped in the last 5 years to 4% for complex transposition and 0% for simple transposition. Of 151 survivors, 2 died late; 1 died of persisting pulmonary hypertension and 1 died of ventricular fibrillation after coronary pathologic changes. At last follow-up, a total of 145 patients were in New York Heart Association functional class I and 4 patients were in class II. The most frequent complication was pulmonary stenosis, necessitating 45 reinterventions in 26 patients. Left ventricular dysfunction was noted in 5 patients. Arrhythmias were seen in 5 patients: 2 patients had ventricular fibrillation (1 died and 1 required a defibrillator implantation), 1 had sick sinus syndrome, 1 had atrial flutter, and 1 had a single attack of supraventricular tachycardia. Aortic valve incompetence was absent or trivial in 146 patients, 3 had mild incompetence, 1 had moderate incompetence, and 1 had severe incompetence. Coronary sequelae were found in 5 of the 61 patients who underwent angiography. Conclusion: Long-term clinical outcome of the arterial switch operation is good, and perioperative mortality is now low. Morbidity is dominated by pulmonary stenosis and coronary artery disease, with the potential for lethal arrhythmias. J Thorac Cardiovasc Surg 2002;124:790-7

Operative technique and results of angioplasty of the left main coronary artery (LMCA) for isolated LMCA disease are reported. Nine consecutive patients, six men and three women, were operated upon. Their ages varied from 46 to 69 years, mean 51 years. All had 50% to 90% stenosis of the LMCA and Class III angina. Cardiopulmonary bypass and a cold cardioplegic solution were used for all operations. There were no operative deaths or infarctions. Follow-up ranged from 0.5 to 4 years, mean 1.9 years. Except for the first patient, who has new stenosis of the proximal anterior descending artery, all patients are free of angina. Repeat angiography in five patients showed a widely patent LMCA with excellent runoff. Our preliminary results suggest that angioplasty of the LMCA can be carried out with low operative risks. The technique appears to be a promising alternative to coronary artery bypass grafting in isolated LMCA disease.