Comparative Outcomes of Primary Arterial Switch Operation for Transposition of Great Arteries within the First Month of Life

  • Hamid Bigdelian Mail Department of Cardiovascular Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
  • Mohsen Sedighi Department of Cardiovascular surgery, Chamran Heart Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Keywords:
Heart defects; congenital, Transposition of great vessels, Thoracic surgery

Abstract

Background: The optimal surgical plan to correct the simple transposition of the great arteries (TGA) is the arterial switch operation (ASO). This study aimed to assess the outcomes of ASO in infants with simple TGA with a special focus on the time of surgery.

Methods: This retrospective study enrolled 105 infants with simple TGA who underwent ASO and categorized them into 3 groups based on the time of repair: first week of life: Group A; second week of life: Group B; and third week of life: Group C. The endpoints, comprised of an assessment of pre- and postoperative outcomes, complications, and survival, were compared between the groups.

Results: The mean age of the infants was 10.50±6.26 days, and 61 (58.1%) cases were male. The mean number of days on dopamine was 1.85±0.12 in Group A, 2.48±0.03 in Group B, and 2.67±0.08 in Group C (P<0.001). The mean number of days on epinephrine was 1.25±0.07 in Group B and 1.27±0.08 in Group C (P<0.001). The mean number of days on the ventilator was 3.52±0.20 in Group A, 4.56±0.24 in Group B, and 5.06±0.21 in Group C (P<0.001). The mean number of days of ICU stay was 6.69±0.21 in Group A, 8.46±0.57 in Group B, and 9.70±0.64 in Group C (P<0.001). The infants in Group A had a greater survival rate (97.0%) than those in Group B (94.1%) and Group C (78.4%) (P=0.042).

Conclusion: ASO in infants with simple TGA can be done within the first week of life with satisfactory outcomes and survival.

References

1. Mbuagbaw L, Forlemu-Kamwa D, Chu A, Thabane L, Dillenberg R. Outcomes after corrective surgery for congenital dextro-transposition of the great arteries using the arterial switch technique: a protocol for a scoping systematic review. BMJ Open 2014;4:e005123.
2. Khairy P, Clair M, Fernandes SM, Blume ED, Powell AJ, Newburger JW, Landzberg MJ, Mayer JE, Jr. Cardiovascular outcomes after the arterial switch operation for D-transposition of the great arteries. Circulation 2013;127:331-339.
3. Daebritz SH, Nollert G, Sachweh JS, Engelhardt W, von Bernuth G, Messmer BJ. Anatomical risk factors for mortality and cardiac morbidity after arterial switch operation. Ann Thorac Surg 2000;69:1880-1886.
4. Hehir DA, Dominguez TE, Ballweg JA, Ravishankar C, Marino BS, Bird GL, Nicolson SC, Spray TL, Gaynor JW, Tabbutt S. Risk factors for interstage death after stage 1 reconstruction of hypoplastic left heart syndrome and variants. J Thorac Cardiovasc Surg 2008;136:94-99.
5. Karamlou T. Optimal timing for arterial switch in neonates with transposition of the great arteries: an elusive target. J Am Coll Cardiol 2014;63:488-489.
6. Kang N, de Leval MR, Elliott M, Tsang V, Kocyildirim E, Sehic I, Foran J, Sullivan I. Extending the boundaries of the primary arterial switch operation in patients with transposition of the great arteries and intact ventricular septum. Circulation 2004;110:123-127.
7. Boutin C, Wernovsky G, Sanders SP, Jonas RA, Castaneda AR, Colan SD. Rapid two-stage arterial switch operation: evaluation of left ventricular systolic mechanics late after an acute pressure overload stimulus in infancy. Circulation 1994;90:1294-1303
8. Kirklin JK, Pacifico AD, Kirklin JW. Intraventricular tunnel repair of double outlet right ventricle. J Card Surg 1987;2:231-245.
9. Bigdelian H, Sedighi M. The role of preoperative sildenafil therapy in controlling of postoperative pulmonary hypertension in children with ventricular septal defects. J Cardiovasc Thorac Res 2017;9:179-182.
10. Bigdelian H, Sedighi M. Repair of Tetralogy of Fallot in Infancy via the Atrioventricular Approach. Korean J Thorac Cardiovasc Surg 2016;49:9-14.
11. Weyman AE, Wann S, Feigenbaum H, Dillon JC. Mechanism of abnormal septal motion in patients with right ventricular volume overload: a cross-sectional echocardiographic study. Circulation 1976;54:179-186.
12. Norwood WI, Dobell AR, Freed MD, Kirklin JW, Blackstone EH. Intermediate results of the arterial switch repair: a 20-institution study. J Thorac Cardiovasc Surg 1988;96:854-863.
13. Bigdelian H, Ghaderian M, Sedighi M. Surgical repair of Tetralogy of Fallot following primary palliation: Right ventricular outflow track stenting versus modified Blalock-Taussig shunt. Indian Heart J 2018;70:394-398.
14. Ismail SR, Kabbani MS, Najm HK, Abusuliman RM, Elbarbary M. Early outcome for the primary arterial switch operation beyond the age of 3 weeks. Pediatr Cardiol 2010;31:663-667.
15. Davis AM, Wilkinson JL, Karl TR, Mee RB. Transposition of the great arteries with intact ventricular septum: arterial switch repair in patients 21 days of age or older. J Thorac Cardiovasc Surg 1993;106:111-115.
16. Duncan BW, Poirier NC, Mee RB, Drummond-Webb JJ, Qureshi A, Mesia CI, Graney JA, Malek CL, Latson LA. Selective timing for the arterial switch operation. Ann Thorac Surg 2004; 77:1691-1696.
Published
2020-01-29
How to Cite
1.
Bigdelian H, Sedighi M. Comparative Outcomes of Primary Arterial Switch Operation for Transposition of Great Arteries within the First Month of Life. J Tehran Heart Cent. 15(1):1-5.
Section
Original Article(s)