COMPARAISON DES RESULTATS A LONG TERME DU SWITCH ARTERIEL ET DE L'OPERATION DE SENNING DANS LA TRANSPOSITION DE GROS VAISSEAUX A SEPTUM INTACT

One hundred and five survivors after the 30th day of complete cure of transposition of the great arteries with intact ventricular septum between 1980 and 1985 were followed up. Fifty-four had an arterial switch (AS) in a single stage at an average age of 10 ± 9 days and 51 had Senning's procedure (S) at an average age of 4 ± 2.5 months. The average follow-up (97% of patients) was 5.8 ± 1.1 years for the AS group and 9.3 ± 2.3 years for the S group. The actuarial survival at 5 years was 100% in the AS group and 85.8% in the S group (p < 0.01) (8 late deaths). In the AS group, 3 patients were reoperated for stenosis of the pulmonary artery and, in the S group, 4 patients underwent 6 reoperations. All but 3 patients in the S group and all but 1 patient in the AS group are in functional Class I of the NYHA classification. Doppler echocardiographic studies have shown mild to severe dysfunction of the systemic ventricle in 2% of the AS group and 26% of the S group (p < 0.001). Holter monitoring, performed in 70% of patients in the S group showed sinus node dysfunction in 60% and sinus rhythm in 40% of cases. In conclusion, good functional results were observed at over 5 years in both groups. However, the absence of late mortality and the minimal incidence of systemic ventricular dysfunction in the AS group confirm the authors' choice of indication of arterial switch for the treatment of transpositon of the great arteries with intact ventricular septum.