Abstract
Background
Current reports favour primary arterial switch (ASO) in infants with d-transposition of great vessels (d-TGA) with intact ventricular septum (IVS) who present later than 21 days. The premise is that the regressed left ventricle (LV) will still adapt to the systemic circulation.
Methods
We compared a retrospective group of 11 infants (group A) who had undergone rapid two stage ASO with those (group B) who had undergone primary ASO (n=15).
Results
The age range (25–70 days), weight (2.5–4.0 Kg), posterior wall thickness of LV (2.8 mm–4.2 mm) and other pre-operative criteria were similar in both groups. In group A, 3/11 infants died after first stage, one each due to shunt blockade, tight pulmonary artery band, and after emergency Senning operation following cardiac failure. Of the remaining eight who underwent ASO 5–9 days after first stage, three died, one each due to fungal infection, sepsis and multi-organ failure, and massive haemorrhage from internal mammary artery. Success of LV training was 8/11 (73%) while overall survival was 5/11 (45%). In group B (15 infants), 13 survived (86%), two needing post-operative extracorporeal membrane oxygenator (ECMO) support and two deaths occurred due to immediate post-operative cardiac failure.
Conclusions
This study demonstrates that primary ASO can show benefit in infants of d-TGA with IVS presenting between 21 to 60 days of age as compared to rapid two stage ASO. These infants might need more support for the ventricular function in form of prolonged inotropes and ECMO support.
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References
Kang N, de Leval MR, Elliott M, Tsang V, Kocyildirim E, Sehic I, et al. Extending the boundaries of the primary arteial switch operation in patients with transposition of the great arteries and intact ventricular septum. Circulation. 2004; 110: 123–27.
Kirklin JW, Blackstone EH, Tchervenkov CI, Castaneda AR. Clinical outcomes after the arterial switch operation for transposition. Patient, support, procedural, and institutional risk factors. Congenital Heart Surgeons Society. Circulation 1992; 86: 1501–15.
Foran JP, Sullivan ID, Elliott MJ, de Leval MR. Primary arterial switch operation for transposition of the great arteries with intact ventricular septum in infants older than 21 days. J Am Coll Cardiol. 1998; 31: 883–89.
Davis AM, Wilkinson JL, Karl TR, Mee RB. Transposition of the great arteries with intact ventricular septum. Arterial switch repair in patients 21 days of age or older. J Thorac Cardiovasc Surg. 1993; 106: 111–15.
Norwood WI, Dobell AR, Freed MD, Kirklin JW, Blackstone EH. Intermediate results of the arterial switch repair. A 20-institution study. J Thorac Cardiovasc Surg. 1988; 96: 854–63.
Yacoub MH, Radley-Smith R, Maclaurin R. Two-stage operation for anatomical correction of transposition of the great arteries with intact interventricular septum. Lancet. 1977; 1: 1275–78.
Jonas RA, Giglia TM, Sanders SP, et al. Rapid two-stage arterial switch for transposition of the great arteries and intact ventricular septum beyond the neonatal period. Circulation. 1989; 80: 1203–08.
Lacour-Gayet F, Piot D, Zoghbi J, Serraf A, Gruber P, Mace L, et al. Surgical management and indication of left ventricular retraining in arterial switch for transposition of the great arteries with intact ventricular septum. Eur J Cardiothorac Surg. 2001; 20: 824–29.
Iyer KS, Sharma R, Kumar K, Bhan A, Kothari SS, Saxena A, et al. Serial echocardiography for decision making in rapid two-stage arterial switch operation. Ann Thorac Surg. 1995; 60: 658–64.
Boutin C, Wernovsky G, Sanders SP, Jonas RA, Castaneda AR, Colan SD. Rapid two-stage arterial switch operation. Evaluation of left ventricular systolic mechanics late after an acute pressure overload stimulus in infancy. Circulation. 1994; 90: 1294–303.
Duncan BW, Poirier NC, Mee RB, Drummond-Webb JJ, Qureshi A, Mesia CI, et al. Selective timing for the arterial switch operation. Ann Thorac Surg. 2004; 77: 1691–96; discussion 1697.
Corno AE, Hurni M, Payot M, Sekarski N, Tozzi P, von Segesser LK. Adequate left ventricular preparation allows for arterial switch despite late referral. Cardiol Young. 2003; 13: 49–52.
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Bisoi, A.K., Chauhan, S., Khanzode, S.D. et al. D-Transposition of great vessels with intact ventricular septum presenting at 3–8 weeks: Should all go for rapid two stage arterial switch or primary arterial switch?. Indian J Thorac Cardiovasc Surg 22, 5–9 (2006). https://doi.org/10.1007/s12055-006-0498-8
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DOI: https://doi.org/10.1007/s12055-006-0498-8