Extending the Boundaries of the Primary Arterial Switch Operation in Patients With Transposition of the Great Arteries and Intact Ventricular Septum

Abstract

Background-We have previously suggested that the primary arterial switch operation is a feasible strategy for patients with transposition of the great arteries and intact ventricular septum (TGA-IVS) up to age 2 months. This study reports our current results with this approach and examines whether this policy could be extended beyond age 2 months. Methods and Results-380 patients who underwent arterial switch for TGA-IVS were reviewed. 275 patients were younger than 3 weeks at the time of surgery (early switch group); 105 patients were 3 weeks or older (range, 21 to 185 days) (late switch group). There was no difference in outcome in terms of in-hospital mortality (5.5% versus 3.8%) or need for mechanical circulatory support (3.6% versus 5.7%) between early and late switch groups. However, duration of postoperative ventilation (4.9 versus 7.1 days, Pϭ0.012) and length of postoperative stay (12.5 versus 18.9 days, PϽ0.001) were significantly prolonged in the late switch group. Primary left ventricular failure resulting in death occurred in 2 patients in the late switch group, with no deaths in 9 patients aged 2 to 6 months. Conclusions-This experience confirms that in TGA-IVS, the left ventricle maintains the potential for systemic work well beyond the first month of life. Consequently, neonates at high risk or late referrals can benefit from delayed arterial switch, even beyond age 2 months. However, the need for mechanical support in some of the older patients may limit the widespread adoption of such a strategy.

Late primary arterial switch operation in patients with transposition of great arteries and intact ventricular septum

“…[7,8] However, around 3 to 24% of the children with TGA-IVS are diagnosed after this period. The ratio is higher in developing countries, in particular.…”

“…[4] Recently, primary-ASO was reported in patients with TGA and intact ventricular septum (IVS) presenting after the first three weeks of life. [4][5][6][7][8] In this study, we report the results of late ASO performed in patients with TGA and IVS after the third week of life.…”

Extracorporeal membrane oxygenation as a support for TGA/IVS with low cardiac output syndrome and pulmonary hemorrhage

“…Under this situation, rather than ASO, two-stage ASO is performed [1]. However, many authors thought that the degradation of left ventricle was reversible, and were more inclined to perform primary ASO followed by ECMO support [2][3][4].…”

Ventricular Assist Devices for Pediatric Heart Disease

“…0,3 microgram/kg/min dose of epinephrine), the mechanical support must be activated due to deteriorating symptoms of low cardiac support. Some centers recommend the usage of VAD in semi effective conditions for postcardiotomy patients who develop severe left ventricular failure after ALCAPA (anomalous left coronary artery from the pulmonary artery) procedure and arterial switch operation (survival rate is 90 %) (Del Nido et al, 1999;Kang et al, 2004). Some other centers support the usage of VAD, after Norwood Stage 1 operation.…”