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Original Articles: Pediatric Cardiac

Arterial Switch for Transposition of the Great Vessels and Taussig-Bing Anomaly After Six Months of Age

^a Department of Thoracic and Cardiovascular Surgery, The Second of Chuanbei Clinical Medical College and Nanchong Central Hospital, Nanchong, People's Republic of China
^b Pediatric Center of Cardiac Surgery, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Science and Beijing Union Medical College, Beijing, People's Republic of China

Accepted for publication August 20, 2009.

^_* Address correspondence to Dr Feng, Department of Thoracic and Cardiovascular Surgery, The Second of Chuanbei Clinical Medical College and Nanchong Central Hospital, Sichuang Province, Nanchong, 637000, People's Republic of China (Email: fsn9977{at}yahoo.com.cn).

Background: Indications and outcomes of the arterial switch operation in children who are older than 1 month of age and have transposition of the great arteries plus ventricular septal defect or Taussig-Bing anomaly were studied.

Methods: Arterial switch operation was performed in 68 children between January 2000 and December 2008. Thirty infants (1 to 6 months old) had transposition of the great arteries plus ventricular septal defect or Taussig-Bing anomaly (group A), and 38 children older than 6 months of age had transposition of the great arteries plus ventricular septal defect or Taussig-Bing anomaly (group B). The preoperative pulmonary artery pressure in group B was significantly higher than that in group A (46.5 ± 16.3 mm Hg and 31.3 ± 8.6 mm Hg, respectively; p < 0.05). Arterial switch operation was performed under general anesthesia, hypothermia (18° to 22°C), and low-flow (50 mL · kg^–1 · min^–1) extracorporeal bypass circulation. Concomitant cardiac anomalies were treated during the same surgical session.

Results: Average extracorporeal circulation time, aortic clamping time, postoperative overall hospitalization, and intensive care unit duration were not significantly different between the two groups (p > 0.05). The operative mortality rate in group A was 10.0% (3 of 30 patients) and in group B, 7.9% (3 of 38 patients; p > 0.05). Follow-up examinations in the surviving 62 patients after a mean of 13.5 ± 7.9 months (range, 0.5 to 56 months) showed significantly improved cardiac function without any long-term complications, and no cases of death occurred during this period.

Conclusions: Arterial switch operation shows satisfactory operative outcome of transposition of the great arteries plus ventricular septal defect or Taussig-Bing anomaly in children older than the age of 6 months with moderate-to-severe pulmonary hypertension.