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Differences in clinical outcomes and cost between complex and simple arterial switches

  • Eric R. Griffiths (a1), Nelangi M. Pinto (a2), Aaron W. Eckhauser (a1), Ragheed Al-Dulaimi (a3), Angela P. Presson (a3), David K. Bailly (a4) and Phillip T. Burch (a1)...



This study evaluates the morbidity, mortality, and cost differences between patients who underwent either a simple or a complex arterial switch operation.


A retrospective study of patients undergoing an arterial switch operation at a single institution was performed. Simple cases were defined as patients with d-transposition of the great arteries with usual coronary anatomy or circumflex artery originating from the right with either intact ventricular septum or ventricular septal defect. Complex cases included all other forms of coronary anatomy, aortic coarctation or arch hypoplasia, and Taussig–Bing anomalies. Costs were acquired using an institutional activity-based accounting system.


A total of 98 patients were identified, 68 patients in the simple group and 30 in the complex group. The mortality rate was 2% for the simple and 7% for the complex group, p=0.23. Major morbidities including cardiac arrest, extracorporeal membrane oxygenation, a major coronary event, surgical or catheter-based re-intervention, stroke, or permanent pacemaker placement, non-cardiac surgical procedures, mediastinitis, and sepsis did not differ between the simple and complex groups (16 versus 27%, p=0.16). The complex group had increased bleeding requiring re-exploration (0 versus 10%, p=0.04). Hospital and ICU length of stay did not differ. Complex patients had higher overall hospital costs (simple $80,749 versus complex $97,387, p=0.01) and higher postoperative costs (simple $60,192 versus complex $70,132, p=0.02). The operating room and supplies accounted for the majority of the cost difference.


Complex arterial switches can be safely performed with low rates of morbidity and mortality but at an increased cost.


Corresponding author

Correspondence to: Eric R. Griffiths, MD, Division of Pediatric Cardiac Surgery, University of Utah, 100 N. Mario Capecchi Dr, Salt Lake City, UT 84132, United States of America. Tel: 801 662 5578; Fax: 801-662-5571; E-mail:


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1. Qamar, ZA, Goldberg, CS, Devaney, EJ, Bove, EL, Ohye, RG. Current risk factors and outcomes for the arterial switch operation. Ann Thorac Surg 2007; 84: 871878; discussion 878–879.
2. Wetter, JBE, Sinzobahamvya, N, Blaschzok, HC, Brecher, AM, Urban, AE. Transposition of the great arteries associated with ventricular septal defect: surgical results and long term outcome. Eur J Cardiothorac Surg 2001; 20: 81813.
3. Gottlieb, D, Schwartz, ML, Bischoff, K, Gauvreau, K, Mayer, JE Jr. Predictors of outcome of arterial switch operation for complex D-transposition. Ann Thorac Surg 2008; 85: 16981702; discussion 1702–1703.
4. Hayes, DA, Jones, S, Quaegebeur, JM, et al. Primary arterial switch operation as a strategy for total correction of Taussig-Bing anomaly: a 21-year experience. Circulation 2013; 128: S194S198.
5. Schwarz, F, Blaschczok, HC, Sinzobahamvya, N, et al. The Taussig-Bing anomaly: long-term results. Eur J Cardiothorac Surg 2013; 44: 821827.
6. Institute DCR. STS Congenital Heart Surgery Executive Summary Neonates STS Period ending 06/30/17, 2016: 2–3. Retrieved June 2017 from
7. Wernovsky, G, Sanders, SP. Coronary artery anatomy and transposition of the great arteries. Coron Art Dis 1993; 2: 148157.
8. Khairy, P, Clair, M, Fernandes, SM, et al. Cardiovascular outcomes after the arterial switch operation for D-transposition of the great arteries. Circulation 2013; 127: 331339.
9. Sarris, GE, Chatzis, AC, Giannopoulos, NM, et al. The arterial switch operation in Europe for transposition of the great arteries: a multi-institutional study from the European Congenital Heart Surgeons Association. J Thorac Cardiovasc Surg 2006; 132: 633639.
10. Villafane, J, Lantin-Hermoso, MR, Bhatt, AB, et al. D-transposition of the great arteries: the current era of the arterial switch operation. J Am Coll Cardiol 2014; 64: 498511.
11. Hawkins, JA, Kaza, AK, Burch, PT, Lambert, LM, Holubkov, R, Witte, MK. Simple versus complex truncus arteriosus: neutralization of risk but with increased resource utilization. World J Pediatr Congenit Heart Surg 2010; 1: 285291.
12. Pasquali, SK. Coronary artery pattern and outcome of arterial switch operation for transposition of the great arteries: a meta-analysis. Circulation 2002; 106: 25752580.
13. Stoica, S, Carpenter, E, Campbell, D, et al. Morbidity of the arterial switch operation. Ann Thorac Surg 2012; 93: 19771983.
14. Anderson, BR, Ciarleglio, AJ, Hayes, DA, Quaegebeur, JM, Vincent, JA, Bacha, EA. Earlier arterial switch operation improves outcomes and reduces costs for neonates with transposition of the great arteries. J Am Coll Cardiol 2014; 63: 481487.



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