Emergency Arterial Switch: Rescue Therapy for Life-Threatening Hypoxaemia in Transposition of Great Arteries with Intact Intraventricular Septum

Published:November 21, 2022DOI:
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      A minority of infants with d-loop transposition of the great arteries with intact intraventricular septum (TGA/IVS) have life-threatening refractory hypoxaemia often due to coexistent persistent pulmonary hypertension of the newborn (PPHN). This case series describes the outcomes of a ‘rescue’ emergency arterial switch operation (ASO).


      Retrospective medical record analysis of infants with TGA/IVS who underwent an ASO in New Zealand from 1st January 1996 to 30th April 2017. Data were compared between those who received an emergency ASO and those with a non-emergency ASO for descriptive purposes. An emergency ASO was defined as one that was undertaken for life-threatening refractory hypoxemia where the only alternative stabilisation strategy was preoperative extracorporeal life support (ECLS). Primary outcome measures were 30-day postoperative mortality and abnormal neurodevelopmental outcome in the survivors. Secondary outcomes were low cardiac output, arrhythmia, renal dysfunction, postoperative seizures, and length of stay. Other known risk factors for morbidity and mortality were also assessed.


      272 infants underwent an ASO with 25 (9%) receiving an emergency ASO. No infants received preoperative ECLS. The Emergency Group had greater 30-day postoperative mortality (8.0% vs 0.4%; p = 0.01) with no difference in abnormal neurodevelopmental outcome amongst the survivors (17.4% vs 13.8%; p = 0.35). The Emergency Group had more therapies for low cardiac output syndrome (LCOS), more postoperative seizures, and a longer length of stay.


      An emergency ASO is a definitive rescue therapy that can be undertaken with acceptable mortality and neurodevelopmental outcome given the preoperative clinical state.

      Graphical abstract


      Abbreviations and Acronyms:

      ASO (arterial switch operation), BAS (balloon atrial septostomy), CPB (cardiopulmonary bypass), TGA/IVS (d-loop transposition of the great arteries with intact intraventricular septum), ECLS (extracorporeal life support), LOS (length of stay), LCOS (low cardiac output syndrome), PICU (paediatric intensive care unit), PGE1 (prostaglandin E1), PPHN (persistent pulmonary hypertension of the newborn), ECMO (extracorporeal membrane oxygenation), VIS (vasoactive-inotropic score)
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