Abstract
Objective
A small percentage of infants with d-loop transposition of the great arteries with
intact intraventricular septum have life-threatening refractory hypoxemia often due
to coexistent persistent pulmonary hypertension of the newborn. In this case series
we describe the outcomes of a “rescue” emergency arterial switch operation (ASO).
Methods
We undertook a retrospective medical record analysis of infants with d-loop transposition
of the great arteries with intact intraventricular septum who underwent an ASO in
New Zealand from January 1, 1996, to April 30, 2017. Data were compared for those
who received an emergency ASO and those with a nonemergency ASO for descriptive purposes.
An emergency ASO was defined as one that was undertaken for life-threatening refractory
hypoxemia when the only alternative stabilization strategy was preoperative extracorporeal
life support. 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
Two hundred seventy-two infants underwent an ASO with 25 (9%) who received an emergency
ASO. No infants received preoperative extracorporeal life support. The emergency group
had greater 30-day postoperative mortality (8.0% vs 0.4%; P = .01) with no difference in abnormal neurodevelopmental outcome among the survivors
(17.4% vs 13.8%; P = .35). The emergency group had more therapies for low cardiac output syndrome, 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 with consideration of the preoperative clinical
state.
Graphical abstract
Graphical Abstract
Key Words
Abbreviations and Acronyms:
ASO (arterial switch operation), BAS (balloon atrial septostomy), CPB (cardiopulmonary bypass), ECLS (extracorporeal life support), LCOS (low cardiac output syndrome), maxVIS (maximum vasoactive-inotropic score), PGE1 (prostaglandin E1), PPHN (persistent pulmonary hypertension of the newborn), TGA/IVS (d-loop transposition of the great arteries with intact intraventricular septum)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 21, 2022
Accepted:
November 11,
2022
Received in revised form:
November 7,
2022
Received:
August 26,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 by The American Association for Thoracic Surgery
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- Commentary: Emergent arterial switch for critically ill babies with transpositionThe Journal of Thoracic and Cardiovascular Surgery
- PreviewAmong the most important advances over the past 2 decades in the field of congenital heart surgery has been the development and refinement of emergency extracorporeal membrane oxygenation (ECMO). Whether dealing with cardiac arrest after surgery or arrival in the middle of the night of an undiagnosed neonate, generic arteriovenous ECMO smoothly instituted by a coordinated experienced team has become the hallmark of every high quality, busy congenital program. ECMO allows for stabilization, thoughtful and accurate diagnosis, and time to develop a longer-term plan.
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