Background: The arterial switch operation has been considered one of the more difficult operations of the heart. Aside from the technical aspects, preoperative preparations have been crucial in the postoperative outcomes of patients. Neonatal intervention has been the standard of care, however, older patients have been successfully operated so that factors need to be reevaluated.
Method: This is a retrospective study done in the Philippine Heart Center on arterial switch operations from January 2006 to December 2014. Medical records of 137 patients were reviewed. Emergency cases and those with prior surgeries were excluded from the study. Only the preoperative and intraoperative data were collected and analyzed in relation to mortality.
Results: The in-hospital mortality rate is 35%; with the highest mortality rate at 82% in 2006 and lowest at 12% in 2008. Bypass time was shown to be significant risk factor for mortality (p-value=0.006; odds ratio=1.018) as well as the length of the patients (p-value=0.035; odd ratio=0.919). Other parameters such as age at the time of surgery (3weeks vs older patients), sex, weight, body surface area, and presence of ventricular septal defect were not found to be significant. Intraoperative factors such as crossclamp time and cardiopulmonary bypass lowest temperature, the need for total circulatory arrest or low-flow cardiopulmonary bypass, associated aortic arch obstruction, and whether the patient had delayed sternal closure were also not significant.
Conclusion: Arterial switch operation remains to be a high risk operation especially in the Philippine Heart Center. The high overall mortality is not only related to the complexity of the procedure but also to the preoperative variables of the patient and even a center-specific limitation. In the absence of a practice guideline at present, the surgeon and the team taking care of the patient may have to decide amongst themselves, the operability of the patients.