Preoperative Factors as a Predictor for Early Postoperative Outcomes After Repair of Congenital Transposition of the Great Arteries

Abstract

Transposition of the great arteries (TGA) requires early surgical repair during the neonatal period. Several preoperative factors have been identified for the postoperative poor outcome after arterial switch operation (ASO). However, the data remain uncertain an association. Therefore, we investigated the preoperative factors which affect the early postoperative outcomes. Between March 2005 and May 2012, a retrospective study was performed which included 126 infants with an ASO for TGA. Preoperative data included the vasoactive inotropic score (VIS) and baseline hemodynamics. Early postoperative outcomes included the duration of mechanical ventilation, the length of stay in the intensive care unit and hospital, and early mortality. Multivariate linear regression and receiver operating characteristics analysis were performed. The duration of mechanical ventilation was significantly correlated with the preoperative mechanical ventilator support and VIS, and CPB time. On multivariate linear regression analysis, a higher preoperative VIS, preoperative B-type natriuretic peptide (BNP) level, and the CPB time were identified as independent risk factors for delayed mechanical ventilation. Preoperative VIS (OR 1.154, 95 % CI 1.024-1.300) and the CPB time (OR 1.034, 95 % CI 1.009-1.060) were independent parameters predicting early mortality. A preoperative VIS of 12.5 had the best combined sensitivity (83.3 %) and specificity (85.3 %) and an AUC of 0.852 (95 % CI 0.642-1.061) predicted early mortality. Our results suggest that preoperative VIS and BNP can predict the need for prolonged postoperative mechanical ventilation. Moreover, preoperative VIS may be used as a simple and feasible indicator for predicting early mortality.

Transposition of the Great Arteries in Fetal Life: Accuracy of Diagnosis and Short-Term Outcome

“…In our study, simple TGA was found to be slightly more common than the complex forms, a finding which agrees with postnatal series [6,28] but that contrasts with previous prenatal studies reporting that the latter are more common [22]. These discrepancies may be attributed to the degree of distortion of cardiac anatomy that both types of TGA have, and hence, the ease of prenatal detection.…”

Usefulness of the maximum rate of pressure rise in the central and peripheral arteries after weaning from cardiopulmonary bypass in pediatric congenital heart surgery

“…Patients received routine monitoring using 5-lead electrocardiography, pulse oximetry, noninvasive blood pressure, and capnography. In accordance with the standard protocol at our institution, [10,11] anesthesia was induced with midazolam (0.1–0.2 mg/kg), thiopental sodium (1.5–2.0 mg/kg), or ketamine (1–2 mg/kg), as appropriate. After the patient received vecuronium (0.15 mg/kg) and fentanyl (1–3 μg/kg), tracheal intubation was performed.…”

Intramural Ventricular Septal Defect Is a Distinct Clinical Entity Associated With Postoperative Morbidity in Children After Repair of Conotruncal Anomalies

“…Parameters assessed included baseline demographics and potential clinical risk factors for postoperative morbidity and mortality 5-9 (Supplemental Table 1). The Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery STAT mortality categories 10 and operative times were abstracted from the institutional surgical database.…”