Arterial Switch Operation in Transposition of the Great Arteries (Jatene Procedure)

Currently "arterial switch" procedure is the treatment of choice for the transposition of great arteries in most of the major surgical centers dealing with congenital heart disease. In this study we retrospectively examined our results for arterial switch procedure at the Florence Nightingale Hospital between August, 1997 and December, 2000. During this period 60 patients underwent arterial switch operation. The diagnosis was simple transposition in 37 and complex TGA in 23. In the simple transposition group 23 were operated before 15 days of age (early TGA group) and 9 patients underwent surgery between 15 to 45 days (Iate TGA group). Remaining 5 patients in simple TGA group (ages 30 days to 7 years) had two-stage arterial switch procedure. The mean age in complex TGA group was 9 months (18 days to 2 years). The overall hospital mortality was 13%. The mortality in both "early" simple TGA and complex TGA group was similar (9%). There was no mortality in the twostage repair group. However, in the "Iate" simple TGA group the mortality was significantly high (44%). We concluded that arterial switch operation that provides both anatomical and physiologic correction in TGA can be performed with low morbidity and mortality if appropriate preoperative evaluation , timing of surgery and postoperative management is applied. We believe the morta lity significantly increases in patients operated later than 15 days of age especially if the echocardiographic evaluation reveals unfavorable left ventricle morphology to recommend the "two-stage approach" in this patient population.