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Past, present, and future of the arterial switch operation: historical review

Published online by Cambridge University Press:  18 January 2013

Ali Dodge-Khatami ,
Constantine Mavroudis ,
Constantine D. Mavroudis  and
Jeffrey P. Jacobs
Ali Dodge-Khatami*
Affiliation:
Division of Pediatric and Congenital Cardiac Surgery, University Heart Center, University of Hamburg, Hamburg, Germany
Constantine Mavroudis
Affiliation:
Johns Hopkins Children's Heart Surgery, Florida Hospital for Children, Orlando, Florida, United States of America
Constantine D. Mavroudis
Affiliation:
Division of Cardiothoracic Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
Jeffrey P. Jacobs
Affiliation:
Johns Hopkins Children's Heart Surgery, All Children's Hospital and Florida Hospital for Children, Saint Petersburg, Tampa, and Orlando, Florida, United States of America
*
Correspondence to: Dr A. Dodge-Khatami, MD, PhD, Division of Pediatric and Congenital Cardiac Surgery, University of Hamburg, Martinistrasse 52, 20246 Hamburg, Germany. Tel: +49 7410 58221; Fax: +49 7410 58275; E-mail: adodgekhatami@googlemail.com
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Abstract

The arterial switch operation is the extant surgical correction after a long series of palliations attempted and/or successfully achieved for the treatment of discordant ventriculoarterial connections. As early as 1954, pioneers such as Mustard, Bailey, Kay, and Idriss led the way with at first disheartening failures, temporarily leading to abandoning the procedure. The first successful atrial baffle procedure in 1958 established itself as the procedure of choice for treating discordant ventriculoarterial connections, but tenacity, courage, and vision to pursue anatomic correction finally led to the first successful arterial switch in 1975 by Jatene. After a decade to perfect surgical technique and timing indications for the various anatomic subtypes, the new era of the neonatal arterial switch since the late 1980s set the very high standards that we all know and expect today. Despite excellent early and long-term survival, important residual lesions are increasingly being recognised. Expected anatomic residuals include supravalvar pulmonary stenosis, neoaortic valve insufficiency, and coronary ostial stenosis. Reinterventions and rare, but challenging surgical reoperations address these residual findings with satisfactory outcomes. Quality of life into young adulthood is satisfactory, but functional problems include reduced exercise capacity, diffuse coronary insufficiency, and neurodevelopmental shortcomings, of which the true incidence and potential clinical implications are still unknown. The arterial switch is a spectacular anatomic correction for a once lethal condition and currently the best surgical solution for patients with discordant ventriculoarterial connections. It is, however, far from a true cure; closer and ongoing follow-up for future care will continue to be required.

Type
Original Article
Information
Cardiology in the Young , Volume 22 , Issue 6: A Lifelong Interdisciplinary Approach to Common Arterial Trunk, Transposition of the Great Arteries, and Other Evolving Challenges in Paediatric and Congenital Cardiac Disease , December 2012 , pp. 724 - 731
Copyright
Copyright © Cambridge University Press 2012

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