Surgical Age and Morbidity After Arterial Switch for Transposition of the Great Arteries

Ahlström, Love; Odermarsky, Michal; Malm, Torsten; Ramgren, Jens Johansson; Hanséus, Katarina; Liuba, Petru

doi:10.1016/j.athoracsur.2019.04.033

Cited by 7 publications

(11 citation statements)

References 24 publications

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“…(5) cardiac anatomy and coronary artery pattern; (6) operative data, including age and weight at surgery, transfusion during the course of cardiopulmonary bypass (CPB), and intraoperative death; (7) details on postoperative treatment, such as extracorporeal membrane oxygenation (ECMO), cardiac arrhythmia requiring medication or pacing, duration of postoperative ventilation, postoperative co-morbidities, including NEC and culture-proven sepsis, and postoperative mortality; (8) duration of hospitalization and overall mortality.…”

Section: Methodsmentioning

confidence: 99%

“…ASO is typically performed shortly after birth, and delay of surgery is associated with increased morbidity and mortality [6]. Prematurity has been described as risk factor for perioperative morbidity, increased length of postoperative hospitalization, and in-hospital mortality in newborns with d-TGA [7][8][9][10]. In addition, premature infants with d-TGA are likely to be of low birth weight.…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Prematurity on Morbidity and Mortality in Newborns with Dextro-transposition of the Great Arteries

et al. 2021

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Prematurity is a risk factor for adverse outcomes after arterial switch operation in newborns with d-TGA (d-TGA). In this study, we sought to investigate the impact of prematurity on postnatal and perioperative clinical management, morbidity, and mortality during hospitalization in neonates with simple and complex d-TGA who received arterial switch operation (ASO). Monocentric retrospective analysis of 100 newborns with d-TGA. Thirteen infants (13.0%) were born premature. Preterm infants required significantly more frequent mechanical ventilation in the delivery room (69.2% vs. 34.5%, p = 0.030) and during the preoperative course (76.9% vs. 37.9%, p = 0.014). Need for inotropic support (30.8% vs. 8.0%, p = 0.035) and red blood cell transfusions (46.2% vs. 10.3%, p = 0.004) was likewise increased. Preoperative mortality (23.1% vs 0.0%, p = 0.002) was significantly increased in preterm infants, with necrotizing enterocolitis as cause of death in two of three infants. In contrast, mortality during and after surgery did not differ significantly between the two groups. Cardiopulmonary bypass times were similar in both groups (median 275 vs. 263 min, p = 0.322). After ASO, arterial lactate (34.5 vs. 21.5 mg/dL, p = 0.007), duration of mechanical ventilation (median 175 vs. 106 h, p = 0.038), and venous thrombosis (40.0% vs. 4.7%, p = 0.004) were increased in preterm, as compared to term infants. Gestational age (adjusted unit odds ratio 0.383, 95% confidence interval 0.179–0.821, p = 0.014) was independently associated with mortality. Prematurity is associated with increased perioperative morbidity and increased preoperative mortality in d-TGA patients.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Impact of Prematurity on Morbidity and Mortality in Newborns with Dextro-transposition of the Great Arteries

et al. 2021

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“…7,8 The World Health Organization recognizes infertility as a global public health issue. 9 With the rapid development of fertility treatment, which includes assisted reproductive technology (ART) 10 and non-ART medically assisted treatment, conceiving a child has been possible for infertile couples. Assisted reproductive technology is defined as treatment in which eggs or embryos are handled for the purpose of achieving pregnancy.…”

Section: + Supplemental Contentmentioning

confidence: 99%

Association of Preterm Singleton Birth With Fertility Treatment in the US

et al. 2022

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IMPORTANCEPreterm birth is a global health issue. The association between fertility treatment and preterm singleton births has not been clarified. OBJECTIVE To examine the association between fertility treatment and preterm birth. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used birth data that were submitted by 50 states and the District of Columbia to the National Vital Statistics System database. All mothers in the database who had a singleton live birth from January 1, 2016, to December 31, 2019, were included. Those who had preexisting hypertension or diabetes were excluded. EXPOSURES Fertility treatment categorized as assisted reproductive technology (ART) or non-ART treatment. MAIN OUTCOMES AND MEASURESThe main outcome was a diagnosis of preterm birth, which was defined as birth before 37 complete weeks (<259 days) of gestation. Gestational age was calculated by obstetric estimation at delivery and was collected from the database. RESULTSThe final sample consisted of 14 370 920 mothers (mean [SD] age, 28.79 [5.79] years) with singleton live births. Of these women, 122 944 (0.9%) conceived by ART and 71 176 (0.5%) received non-ART treatment. The prevalence of preterm birth was 7.6% (n = 1 071 994) in natural conception, 10.7% (n = 13 205) in ART, and 9.3% (n = 6629) in non-ART groups. Compared with neonates who were naturally conceived, newborns who were conceived with ART (adjusted risk difference [aRD], 3.10% [95% CI, 2.93%-3.27%]; adjusted odds ratio [aOR], 1.49 [95% CI, 1.46-1.52]; P < .001) and non-ART treatment (aRD, 2.22% [95% CI, 2.00%-2.44%]; aOR, 1.35 [95% CI,; P < .001) had significantly higher risk for preterm birth after full adjustment. These associations were similar in subgroups of participants as defined by baseline characteristics.CONCLUSIONS AND RELEVANCE This study found that singleton neonates who were conceived by fertility treatment had higher rates of preterm birth. Further investigations are warranted into the association between ART or non-ART treatment and the risk of preterm birth in singleton neonates.

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“…By era, early mortality was 24% (8), 9% ( 14), 6% (7), and 3% (3) for eras 1, 2, 3, and 4, respectively (P < .001; Table 2). The most common cause of early mortality was unrecoverable ventricular dysfunction postoperatively (7), postoperative sepsis (5), sudden postoperative cardiac arrest (5), and pulmonary hypertensive crisis (4). The distribution of cause of early mortality differed between eras ( (1), sepsis (1), congestive heart failure (1), multiple organ failure (1), and unknown (2).…”

Section: Survival Outcomesmentioning

confidence: 99%

“…Ventricular septal defect (VSD), patient age, prolonged cardiopulmonary bypass time, and surgeon experience have all been suggested as risk factors for mortality. 7,8 However, data regarding risk factors for specific reoperations are sparse. 3 The purpose of this study is to explore the timing, nature, and risk factors for reoperation after ASO.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Reoperation After Arterial Switch Operation

Patel

Herrmann

Bain

et al. 2021

World J Pediatr Congenit Heart Surg

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Objective: The timing and nature of and risk factors for reoperation after the arterial switch operation in the setting of d-transposition of the great arteries requires further elucidation. Methods: A total of 403 patients who underwent arterial switch operation from 1986 to 2017 were reviewed. Institutional preference was for pulmonary artery reconstruction using a pantaloon patch of fresh autologous pericardium. The targets for coronary artery reimplantation were identified by intermittent root distension. Multivariable analysis was used to identify risk factors for reoperation. Results: Median follow-up was 8.6 years (interquartile range [IQR]: 2-16.9). Pulmonary arterioplasty was the most common reoperation (n = 11, 2.7%) at 3.3 years (IQR: 1.4-11.4) postoperatively. Subvalvar right ventricular outflow tract reconstruction (RVOTR) was required in nine (2.2%) patients at 2.5 years (IQR: 1.1-5.3) postoperatively. Aortic valve repair or replacement (AVR/r) was required in seven (1.7%) patients at 13.6 years (IQR: 10.0-15.8) postoperatively. Aortic root replacement (ARR) and Coronary Artery Bypass Graft/coronary patch arterioplasty were required in five (1.2%) patients each at 13.6 years (IQR: 11.0-15.3) and 11.3 years (IQR: 2.3-13.6) postoperatively, respectively. Taussig-Bing anomaly was a risk factor for any reoperation ( P = .034). Risk factors for specific reoperations included ventricular septal defect for AVR/r ( P = .038), Taussig-Bing anomaly for RVOTR ( P = .004), and pulmonary artery banding for ARR ( P = .028). Conclusions: Pantaloon patch pulmonary artery reconstruction and intermittent neo-aortic root distension during coronary reimplantation have minimized respective outflow tract reoperations. Certain anatomic subsets carry different risks for late reoperation, and pulmonary artery and/or RVOT reinterventions tend to occur sooner than aortic reinterventions. Special attention to these higher risk subpopulations will be critical to optimizing lifelong outcomes.

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Surgical Age and Morbidity After Arterial Switch for Transposition of the Great Arteries

Cited by 7 publications

References 24 publications

The Impact of Prematurity on Morbidity and Mortality in Newborns with Dextro-transposition of the Great Arteries

The Impact of Prematurity on Morbidity and Mortality in Newborns with Dextro-transposition of the Great Arteries

Association of Preterm Singleton Birth With Fertility Treatment in the US

Risk Factors for Reoperation After Arterial Switch Operation

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