Outcomes of Arterial Switch Operation in Children with Transposition of Great Arteries Older than Two Weeks

Objectives: The Arterial Switch Operation (ASO) was first performed by Dr. Adib Dominos Jatene in 1975. At present, the ASO described by Jatene, using the Lecompte maneuver, is considered the gold standard for the treatment of transposition of the great arteries (TGA). The ASO, although complex, has good results when performed within the first 2 weeks of life. Our study aimed to investigate the outcomes of the ASO in children older than 2 weeks with TGA, performed by a single surgeon. Material and Methods: After institutional ethics committee approval, the medical records of children older than 2 weeks who underwent ASO for TGA by a single surgeon between April 2021 and April 2023 were reviewed retrospectively. All 31 children received the same standardized anesthetic management and conduct of cardiopulmonary bypass. The following postoperative variables were recorded – postoperative bleeding/total drain output, mediastinal exploration for postoperative bleeding, acute kidney injury (AKI), ventilator-associated pneumonia, duration of mechanical ventilation, duration of intensive care unit (ICU) and hospital stay, inotropic score (IS), neurological dysfunction (seizures, hypoxic-ischemic encephalopathy), sepsis, extracorporeal membrane oxygenation use, tracheostomy, delayed sternal closure, and 30 days mortality. Results: The 30-day mortality rate was 32.2% (10/31). For analysis, children were divided into two groups: survivors and non-survivors at 30-day post-surgery. AKI occurred in 90% of non-survivors versus 23.8% of survivors ( P = 0.001). Non-survivors had a significantly higher ( P < 0.001) incidence of postoperative complications, septic shock, intrapulmonary hemorrhage, or refractory cardiogenic shock. Non-survivors also had significantly higher ISs (27.00 ± 9.49 vs. 18.24 ± 6.80; P = 0.007), higher total drain output (36.34 ± 13.12 vs. 24.32 ± 11.41 mL/kg; P = 0.026), and significantly shorter ICU stay (5.56 ± 5.57 vs. 18.76 ± 15.99 days; P = 0.012). Conclusion: The mortality in children who are more than 2 weeks old and undergo an ASO is 32.2%. In this cohort, age and preoperative balloon atrial septostomy were not associated with 30-day mortality. AKI and other postoperative complications, such as sepsis and left ventricular failure, were associated with increased mortality. Postoperative parameters, such as IS and total drain output, also showed strong associations with 30-day mortality.