Background: Whether an arterial switch operation benefits patients with transposition of the great arteries and severe pulmonary hypertension (PH) remains controversial. Therefore, we evaluated the relationship between preoperative PH and early and midterm clinical outcomes after an arterial switch procedure.
Methods: In this retrospective study, 101 consecutive patients with transposition of the great arteries underwent an arterial switch operation between February 2004 and October 2007. Seventy had a ventricular septal defect as well; patients with intact ventricular septum and complicated concomitant 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 according 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 postoperative 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 mortality differed significantly (control group, 4.3%; moderate PH group, 2.7%; severe PH group, 40%; p<0.01).
Conclusions: Patients with transposition of the great arteries 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 pressure, patients with preoperative mPAP greater than 50 mm Hg still suffer from high midterm mortality.
Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.