Short-term predictors of morbidity and mortality after surgery for transposition of the great arteries.

Abstract

Background: Dextro-transposition of the great arteries is one of the most common cyanotic congenital heart diseases in newborns. Today's first-choice surgery is the arterial switch. This study aims to analyze predictors (<30 postoperative days) of short-term morbidity and mortality after arterial switch at HUDERF and to compare them between simple (without VSD) and complex transpositions (with VSD with/without left/right ventricular outflow tract obstruction or aortic arch anomalies) and between premature and full-term newborns.

Methods: A retrospective single-center cohort study was conducted, reviewing the records of patients with transposition of the great arteries operated at HUDERF between 1997-2023. Patients were divided into simple and complex transpositions, and premature and full-term newborns.

Results: 171 patients were included: 113 simple transpositions and 58 complex. In the early postoperative period, seven (4%) patients died, 89 (52%) had heart failure, and 3 (2%) had myocardial ischemia. 33 (19%) had pulmonary stenosis. Complex morphology was a risk factor for early morbidity and mortality (p = 0.01). Premature newborns had higher morbidity and mortality rates than full-term newborns (12% vs 3%). Early reoperation was performed in 15 patients (9%) and late in 9 (6%). Complex morphology was a risk factor for early (p = 0.0047) and late reoperation (p = 0.048).

Conclusions: Early morbidity, early mortality and reoperation rates were higher in complex transpositions, particularly among premature newborns. Heart failure and pulmonary stenosis were the most common early complications. Heart failure was the main factor associated with early mortality. Pulmonary stenosis was one of the most frequent causes of reoperations.