Factors influencing early and late outcome of the arterial switch operation for transposition of the great arteries Gil Wernovsky, MD* (by invitation),

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Presentation transcript:

Factors influencing early and late outcome of the arterial switch operation for transposition of the great arteries Gil Wernovsky, MD* (by invitation), John E. Mayer, MD, Richard A. Jonas, MD, Frank L. Hanley, MD, Eugene H. Blackstone, MD, John W. Kirklin, MD, Aldo R. Castañeda, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 109, Issue 2, Pages 289-302 (February 1995) DOI: 10.1016/S0022-5223(95)70391-8 Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 1 Cumulative frequency distribution of age at arterial switch repair in patients with TGA and IVS and in those with a coexisting VSD. BCH, Boston Children's Hospital. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 289-302DOI: (10.1016/S0022-5223(95)70391-8) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 2 Cumulative frequency distribution of the duration of circulatory arrest. BCH, Boston Children's Hospital. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 289-302DOI: (10.1016/S0022-5223(95)70391-8) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 3, A and B. Risk-unadjusted survival after the arterial switch repair. Each circle represents a death; the circles are positioned along the horizontal axis at the time of death and along the vertical axis according the Kaplan-Meier estimate. The numbers in parentheses indicate the number of patients available for follow-up at the time of the underlying circle. The vertical bars represent the 70% confidence intervals around the Kaplan-Meier estimate. The solid line, with its 70% confidence limits enclosed by the dashed lines, represent the survivorship estimates according to the hazard function regression method. The dash-dot-dash line is the survivorship of an age, gender, race-matched general population. A, Survival; B, hazard function for death. BCH, Boston Children's Hospital. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 289-302DOI: (10.1016/S0022-5223(95)70391-8) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 3, A and B. Risk-unadjusted survival after the arterial switch repair. Each circle represents a death; the circles are positioned along the horizontal axis at the time of death and along the vertical axis according the Kaplan-Meier estimate. The numbers in parentheses indicate the number of patients available for follow-up at the time of the underlying circle. The vertical bars represent the 70% confidence intervals around the Kaplan-Meier estimate. The solid line, with its 70% confidence limits enclosed by the dashed lines, represent the survivorship estimates according to the hazard function regression method. The dash-dot-dash line is the survivorship of an age, gender, race-matched general population. A, Survival; B, hazard function for death. BCH, Boston Children's Hospital. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 289-302DOI: (10.1016/S0022-5223(95)70391-8) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 4 The risk-adjusted relation of age at operation to percent mortality within 6 months of operation in patients with an intact ventricular septum, without dextrocardia, with the usual coronary pattern, and with 35 minutes of circulatory arrest. The depiction is a nomogram of the multivariable equation entering patient-specific, procedural, and support variables only (without the experience variable, not reproduced). BCH, Boston Children's Hospital. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 289-302DOI: (10.1016/S0022-5223(95)70391-8) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 5 The risk-adjusted percent survival after the arterial switch operation in patients without dextrocardia, according to the coronary artery pattern. The nomogram is a solution of the multivariable equation entering patient-specific risk factors only (dextrocardia and coronary patterns, not reproduced in detail). 2LADCxR, inverted coronary pattern; 1R2LADCx, single right coronary artery pattern; BCH, Boston Children's Hospital. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 289-302DOI: (10.1016/S0022-5223(95)70391-8) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 6 Nomogram showing the relation between the duration of circulatory arrest and the risk-adjusted percent mortality within 6 months in patients with IVS, usual coronary pattern, without dextrocardia, and 6 days of age at the time of the repair. The depiction is a specific solution of the multivariable equation in Table III. BCH, Boston Children's Hospital. TCA, Total circulatory arrest. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 289-302DOI: (10.1016/S0022-5223(95)70391-8) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 7 The risk-adjusted effect of date of operation on survival for at least 6 months after the arterial switch in a 6-day-old neonate with intact ventricular septum, without dextrocardia or arch augmentation, the usual coronary anatomy, and a circulatory arrest time of 35 minutes. Note that after 1986 the risk-adjusted percent survival was the same for all surgeons. The depiction is a nomogram of the multivariable equation in Table III. BCH, Boston Children's Hospital. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 289-302DOI: (10.1016/S0022-5223(95)70391-8) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 8, A and B Risk-unadjusted time-related freedom from reintervention for pulmonary artery (A) or valve (V) stenosis after the arterial switch. The details of the depiction are as in Fig. 3. A, Percent freedom. B, Hazard function. BCH, Boston Children's Hospital. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 289-302DOI: (10.1016/S0022-5223(95)70391-8) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 8, A and B Risk-unadjusted time-related freedom from reintervention for pulmonary artery (A) or valve (V) stenosis after the arterial switch. The details of the depiction are as in Fig. 3. A, Percent freedom. B, Hazard function. BCH, Boston Children's Hospital. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 289-302DOI: (10.1016/S0022-5223(95)70391-8) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 9, A and B. Risk-unadjusted time-related freedom from reintervention for obstruction in the left ventricular (LV) outflow tract or aortic (Ao) arch after the arterial switch. The details of the depiction are as in Fig. 3. A, Percent freedom. B, hazard function. BCH, Boston Children's Hospital. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 289-302DOI: (10.1016/S0022-5223(95)70391-8) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 9, A and B. Risk-unadjusted time-related freedom from reintervention for obstruction in the left ventricular (LV) outflow tract or aortic (Ao) arch after the arterial switch. The details of the depiction are as in Fig. 3. A, Percent freedom. B, hazard function. BCH, Boston Children's Hospital. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 289-302DOI: (10.1016/S0022-5223(95)70391-8) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 10 Cumulative frequency distribution of the peak systolic ejection gradient from the right ventricle (RV) to distal pulmonary arteries (PA) and from the left ventricle (LV) to the distal aorta (Ao) as determined at cardiac catheterization (median 11.5 months after the operation). BCH, Boston Children's Hospital. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 289-302DOI: (10.1016/S0022-5223(95)70391-8) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 11 Nomogram showing the relation between the date of operation and the predicted peak systolic ejection gradient from the right ventricle (RV) to the distal pulmonary artery (PA) as determined at postoperative catheterization. The depiction is a specific solution of the multivariable equation in Table VI, with 70% confidence limits for an individual patient. BCH, Boston Children's Hospital. The Journal of Thoracic and Cardiovascular Surgery 1995 109, 289-302DOI: (10.1016/S0022-5223(95)70391-8) Copyright © 1995 Mosby, Inc. Terms and Conditions

Fig. 12 Scattergram showing the change in right ventricle (RV) to pulmonary artery (PA) gradient over time, as determined during follow-up by either cardiac catheterization or Doppler echocardiography. A time sequence was generated for each patient, with up to four studies per patient. Patients were removed from further analysis if a surgical or catheterization reintervention was performed, although the pre-reintervention study is shown. Circles represent changes from the first to the second study (n = 168), squares represent changes from the second study to the third study (n = 324), and diamonds represent changes from the third study to the fourth study (n = 12). The Journal of Thoracic and Cardiovascular Surgery 1995 109, 289-302DOI: (10.1016/S0022-5223(95)70391-8) Copyright © 1995 Mosby, Inc. Terms and Conditions