Two-stage anatomical repair of “simple” transposition of great arteries in neonates with extracardiac perinatal complications

Aim. This study was designed to analyse the results of two-stage arterial switch operation (ASO) of “simple” transposition of great arteries in patients with infection, neurological problems or necrotizing enterocolitis, which preclude neonatal surgery. Methods. Transthoracic echocardiography data and outcomes of surgery were investigated in 19 patients (study group; #1) after two-stage ASO and 67 patients (control group; #2) after a single-stage ASO. Age of patients at the first stage was 27 (8-55) days and at the second stage 172 (92-256) days. Patients in group 2 were 7 (2-53) days old. All of them were followed up for 21 (4-49) months (group 1) and 40 (7-79) months (group 2) after arterial switch operation. Results. There was no operative mortality at both stages in group 1. The duration of ventilation, length of intensive care unit and hospital stay after surgery were considerably lower in group 1. Actuarial survival and freedom from reoperation at 4 years in group 1 accounted for 100%, while in the control group those indicators at 6 years ran to 98.5% and 94%, respectively. The only difference detected by echocardiography was the aortic valve hinge points Z-score (3.9±1.44 vs. 3.1 ±1.27; p = 0.025) and sinuses of Valsalva (3.8±1.41 vs. 2.8±1.19; p = 0.03), which were higher in the 1st group. There was no aortic regurgitation >1 grade in both groups. Conclusion. Two-stage repair of “simple” transposition of great arteries, when it’s necessary to delay arterial switch operation on the clinical grounds, can be performed with excellent clinical outcomes. The tendency of group 1 patients to have a larger neoaortic root does not appear to bear any clinical significance in mid-term follow-up.