Early and mid-term outcome of the arterial switch operation in 114 consecutive patients

Prandstetter, Christoph; Hofer, Anna; Lechner, Evelyn; Mair, Rudolf; Sames-Dolzer, Eva; Tulzer, Gerald

doi:10.1007/s00392-007-0546-4

Cited by 28 publications

(22 citation statements)

References 24 publications

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“…Our patients had excellent operative results with mortality less than 1 % which compares favorably to other reports [12,13]. Despite the excellent mortality outcomes, a subgroup of patients had a protracted postoperative length of stay.…”

Section: Commentsupporting

confidence: 51%

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Preoperative Intubation and Lack of Enteral Nutrition are Associated with Prolonged Stay After Arterial Switch Operation

et al. 2016

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Mortality for the arterial switch operation (ASO) has diminished significantly over the past few decades. Some patients do, however, continue to have protracted and complicated courses after surgery. We attempted to determine which preoperative factors were best associated with prolonged hospital stay after ASO. We retrospectively reviewed all patients that underwent an ASO over a 10-year period. Outcomes of patients with postoperative stays (POS) >14 days (long stay group-LS) were compared with those patients with POS < 7 days (short stay group-SS). The following variables were evaluated: age at surgery, weight, septostomy performed (BAS) and management the day prior to surgery including use of prostaglandin E1 (PGE1), inotropes, intubation status and the establishment of enteral feeds. The SS group had 25 patients and the LS group had 32 patients. Both groups (SS vs. LS) were similar in PGE1 use (48 vs. 69 %), BAS (76 vs. 59 %), age at surgery (6 vs. 7 days) and preoperative inotropes (12 vs. 38 %). The SS group had significantly higher incidence of preoperative feeding (80 vs. 31 %, p < 0.001) and less frequent intubation (12 vs. 47 %, p < 0.001). Patients who are intubated and have not yet begun to receive enteral feeds at the time of their ASO are more likely to have prolonged POS. It is unclear if prolonged stays were a result of operating on patients with worse preoperative hemodynamics or a consequence of a preoperative management strategy that did not allow for extubation and establishment of feeds prior to surgery.

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Section: Commentsupporting

confidence: 51%

“…First, we did not describe postoperative residual anatomical lesions, low cardiac output state, and other postoperative factors that might have affected length of stay. Several reports have been published exploring these associations [3,9,[11][12][13]. Furthermore, the cardiopulmonary bypass time was statistically longer in the LL stay group.…”

Section: Commentmentioning

confidence: 86%

Preoperative Intubation and Lack of Enteral Nutrition are Associated with Prolonged Stay After Arterial Switch Operation

et al. 2016

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“…Survival rates for corrective and for complex palliative cardiac surgery procedures in neonates have significantly improved over the last 10 years [1][2][3][4]. The incidence of low weight for gestational age in newborns affected with congenital heart defects has been reported to be significantly higher when compared with the normal newborn population [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Open-heart surgery in premature and low-birth-weight infants — a single-centre experience

Lechner

Wiesinger-Eidenberger

Weissensteiner

et al. 2009

European Journal of Cardio-Thoracic Surgery

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“…The known risk factors for the mortality and morbidity for ASO in complete TGA were combined with anatomical defects, unusual coronary artery anatomy, prolonged CPB time, preterm birth and low body weight at the time of the operation8,10,15,16). Although the presence of a VSD or aortic arch obstruction in complete TGA has been described as a significant risk factor10,17), we showed favorable outcome in spite of different types of TGA anatomy.…”

Section: Discussionmentioning

confidence: 56%

“…Due to the immaturity of organ systems, these patients are exposed to a specific risk resulting from noxious effects of extracorporeal circulation, especially on the central nervous system23,24). Prandstetter et al16) reported that the body weight, less than 2.5 kg at the time of the operation, was the only risk factor for increased hospital mortality. As surgical reasons for the adverse outcome of patients could not be identified, they concluded that immaturity of organ systems is the main reason for the increased risk of mortality and morbidity in this group.…”

Section: Discussionmentioning

confidence: 99%

Clinical features and surgical outcomes of complete transposition of the great arteries

et al. 2012

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PurposeThis single-center study aimed to assess the clinical features and surgical approaches and outcomes of complete transposition of the great arteries (TGA).MethodsTGA patients who had undergone surgical correction at the Kyungpook National University Hospital from January 2000 to December 2010, were retrospectively evaluated for patient characteristics, clinical manifestation, preoperative management, intraoperative findings, postoperative progress, and follow-up status.ResultsTwenty-eight patients (17 boys and 11 girls, mean age=10.6±21.5 days) were included and were categorized as follows: group I, TGA with intact ventricular septum (n=13); group II, TGA with ventricular septal defect (VSD, n=12); and group III, TGA/VSD with pulmonary stenosis (n=3). Group I underwent the most intensive preoperative management (balloon atrial septostomy and prostaglandin E1 medication). Group II showed the highest incidence of heart failure (P<0.05). Usual and unusual coronary anatomy patterns were observed in 20 (71%) and 8 patients, respectively. Arterial and half-turned truncal switch operations were performed in 25 and 3 patients (Group III), respectively. Postoperative complications included cardiac arrhythmias (8 patients), central nervous system complications (3 patients), acute renal failure (1 patient), infections (3 patients), and cardiac tamponade (1 patient), and no statistically significant difference was observed between the groups. Group II showed the mildest aortic regurgitation on follow-up echocardiograms (P<0.05). One patient underwent reoperation, and 1 died. The overall mortality rate was 4%.ConclusionOur study showed favorable results in all the groups and no significant difference in postoperative complication, reoperation, and mortality among the groups. However, our results were inadequate to evaluate the risk factors for reoperation and mortality owing to the small number of patients and short follow-up duration.

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Early and mid-term outcome of the arterial switch operation in 114 consecutive patients

Abstract: The ASO can be performed safely and with low mortality and morbidity even in patients with complex TGA. Follow-up of these patients is required to detect residual problems like supravalvular pulmonary stenosis, coronary problems, arrhythmias and aortic valve dysfunction.

Cited by 28 publications

References 24 publications

Preoperative Intubation and Lack of Enteral Nutrition are Associated with Prolonged Stay After Arterial Switch Operation

Preoperative Intubation and Lack of Enteral Nutrition are Associated with Prolonged Stay After Arterial Switch Operation

Open-heart surgery in premature and low-birth-weight infants — a single-centre experience

Clinical features and surgical outcomes of complete transposition of the great arteries

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