Surgery for Transposition of the Great Arteries in Neonates Weighing Less Than 2,000 Grams: A Consecutive Series of 25 Patients

Background: The arterial switch operation (ASO) is the optimal option for neonates with transposition of the great arteries (TGA). Low birth weight (LBW) and prematurity were considered as risk factors for poor outcome in early corrective surgery for cardiac defects. This retrospective study was undertaken to evaluate early and midterm results in infants with TGA weighing less than 2,000 grams who underwent surgical procedure in the neonatal period. Methods: Among the 1,505 patients who underwent surgical procedure for TGA at our institution, 25 (0.02%) had a birth weight less than 2,000 grams and constituted the study group. Median age at operation was 19 days and median weight was 1,930 grams. Prior to surgery, all were in the intensive care unit. Eleven (48%) with TGA and intact interventricular septum had an ASO but one had a Senning operation. Among 13 patients (52%) with complex TGA, 9 had anatomic repair and 4 had palliation. Results: Operative mortality was 16%. Age at operation greater than 30 days and palliation were risks factors for early death. At postoperative 43 months, actuarial survival rate was 71% and freedom from reoperation rate was 73%. All survivors were considered to have good cardiac status; 95% joined the normal curve for LBW infants without heart defects. Conclusions: These data support that delaying repair in LBW neonates with simple or complex TGA does not confer any benefit and is associated with higher morbidity.