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There is significant morbidity after anatomic repair of ccTGA, which is higher in the DS than the RS group. Nevertheless, the majority of patients are free of heart failure at 10 years, including high-risk patients in severe heart failure before repair. Aortic annuloplasty may reduce risk of late aortic insufficiency.

Special Article responsible in the event of any contradiction, discrepancy and/or ambiguity between the EACTS, EACTA and EBCP Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EACTS, EACTA and EBCP Guidelines fully into account when exercising their clinical judgement as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies; however, the EACTS, EACTA and EBCP Guidelines do not, in any way whatsoever, override the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient's health condition and, where appropriate and/or necessary, in consultation with that patient and the patient's care provider. Nor do the EACTS, EACTA and EBCP Guidelines exempt health professionals from giving full and careful consideration to the relevant official, updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient's case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional's responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription. The article has been co-published with permission in the British Journal of Anaesthesia, the European Journal of Cardio-Thoracic Surgery and the Interactive CardioVascular and Thoracic Surgery.

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Objective: High concentrations of potassium and lactate in irradiated red cells transfused during cardiopulmonary bypass may have detrimental effects on infants and neonates undergoing cardiac surgery. The effects of receiving washed and unwashed irradiated red cells from the cardiopulmonary circuit on serum potassium and lactate concentrations were compared. Methods: The study population included neonates and infants undergoing heart surgery for complex congenital heart disease. A control group (n = 11) received unwashed irradiated red cells and the study group (n = 11) received irradiated red cells washed in a cell saver (Dideco Electa) using 900 ml of 0.9% saline prior to pump priming. Potassium and lactate concentrations were compared before, during and after bypass. Results: Washing irradiated red cells reduced donor blood [potassium] from > 20 to 0.8 AE 0.1 mmol/l, and [lactate] from 13.7 AE 0.5 to 5.0 AE 0.3 mmol/l ( p < 0.001). The resulting prime had significantly lower [potassium] and [lactate] than the unwashed group (potassium 2.6 AE 0.1 vs 8.1 AE 0.4 mmol/l, p < 0.001; lactate 2.6 AE 0.2 vs 4.6 AE 0.3 mmol/l, p < 0.001). Peak [potassium] in the unwashed group occurred 3 minutes after going on bypass (4.9 AE 0.3 mmol/l) and during rewarming (4.9 AE 0.4 mmol/l). These were significantly higher than the washed group (3.1 AE 0.1, p < 0.001 and 3.0 AE 0.1 mmol/l, p < 0.001). The [potassium] was greater than 6.0 mmol/l for 4 out of these 11 unwashed patients compared with none of the washed group. Immediately postbypass the washed group had significantly lower serum [potassium] (3.2 AE 0.1 vs 4.2 AE 0.2 mmol/l, p = 0.002). There was no significant difference in [lactate] between groups during and after cardiopulmonary bypass. Conclusions: The washing of irradiated red cells reduces potassium and lactate loads and prevents hyperkalaemia during cardiopulmonary bypass. The washing of irradiated red cells should be considered in neonates and infants undergoing cardiac surgery for complex congenital heart disease. #

By using a strategy of unifocalization, intrapericardial pulmonary artery reconstruction, and right ventricle-pulmonary artery conduit, excellent long-term survival can be achieved in this group of patients even in the absence of native intrapericardial pulmonary arteries.

Primary RVOT stenting facilitates staged palliation for ToF in small infants and complex anatomies. Improved PA blood flow generated by the stent leads to growth of the branch PAs and may improve the substrate for subsequent surgical repair. Surgery is safe; however, the majority will require a TAP.