Surgical management of transposition of the great arteries

Sixty-two patients with transposition of the great arteries, ranging in age from one week to thirty-five years, underwent total corrective surgery during a seven year period at Stanford University Hospital. Reported herein are the first patient to undergo complete correction at our hospital and every subsequent patient until October 1974. Eleven patients died, an overall hospital mortality of 18 per cent. Two of thirty-two patients with transposition of the great arteries and intact ventricular septum died, one of pulmonary hypertension at seven days of age. Nine of thirty patients with transposition of the great arteries and ventricular septal defect with or without pulmonary stenosis died. Cause of death usually was high pulmonary vascular resistance. The Donovan-Rastelli procedure was performed in ten patients, with three deaths, but all patients survived when the inserted right ventricular outflow contained a xenograft aortic valve. Transposition of the great arteries in the first weeks of life must be considered on the individual merits of each case, but the combined medical and surgical approach must be both expedient and thorough if the patient is to survive.