Advertisement

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

Published:November 21, 2022DOI:https://doi.org/10.1016/j.jtcvs.2022.11.014
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      Objective

      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).

      Methods

      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.

      Results

      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.

      Conclusions

      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

      Keywords

      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)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Thoracic and Cardiovascular Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect