Twenty-one patients (9.4%) had concomitant AAO. Two hundred and twenty-three Jatene operations to treat TGA were performed from January 1998 to December 2005 at the Biocor Institute. Based on our current conduct, in this research we tried to analyze our experience in patients with TGA plus AAO who underwent either the 2-stage repair or simultaneous repair. The anatomical nature of AAO, a higher incidence of coronary anomalies, differences in the calibers of the aorta and the PA, the occurrence of subaortic stenosis and a higher incidence of aortic regurgitation over the long term are among the factors that directly affect the definition of the operative technique to be used, making this group of patients a challenge for the surgical team. Nevertheless, there are several characteristics of patients that directly interfere in the immediate and long-term postoperative outcomes. The introduction of single-stage repair of TGA plus AAO by Pigott in 1988, along with improvements in neonatal surgical techniques, stimulated several centers to abandon the 2-stage repair and adopt the new methodology which is now generally used in the great majority of centers. This form of treatment presented unfavorable results with a high morbimortality rate. Initially, these patients were selected for two-stage surgical repair, with approach of the aortic arch in the first stage, usually accompanied with cerclage of the pulmonary artery (PA) in the second stage, repair of the TGA is performed. Apart from a highly unfavorable prognosis, this association makes the surgical approach complex requiring precise planning in order to obtain good results. Aortic arch obstruction (AAO) is a relatively frequent malformation in some forms of transposition of the great arteries (TGA) associated to ventricular septal defect (VSD) but it is rare in simple TGA with an intact interventricular septum.
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