Does a prenatal diagnosis affect mortality and morbidity for neonatal arterial switch operation

2022 ◽  
pp. 1-5
Author(s):  
Osman Guvenc ◽  
Serdar Beken ◽  
Aysegul Inamlik ◽  
Eda Albayrak ◽  
Bahar Temur ◽  
...  
Keyword(s):  
Prenatal Diagnosis ◽  
Arterial Switch Operation ◽  
Tertiary Care ◽  
Operation Time ◽  
Care Hospital ◽  
Mortality And Morbidity ◽  
Arterial Switch ◽  
Switch Operation ◽  
Neonatal Icu ◽  
Group 1

Abstract Background: The effect of prenatal diagnosis on prognosis in patients with transposition of the great arteries is not clear. In this study, we compared the outcomes after arterial switch operation. Methods: Outcome of 112 patients who had arterial switch operation in the neonatal period were analysed. The patients were divided into two groups: those who had prenatal diagnosis (Group 1; n = 34) and those who did not (Group 2; n = 78). The patients were also classified based on their diagnosis: simple transposition, transposition with ventricular septal defect and/or aortic arch hypoplasia, and Taussig–Bing anomaly. Results: In Group 1, the C-section delivery rate was higher (82% vs. 44%; p = 0.004), and it was observed that patients in Group 1 were more often intubated upon admission to the neonatal ICU (38% vs. 9%; p = 0.005). No differences were found between the two groups in terms of operation time, cardiopulmonary bypass time, post-operative invasive respiratory support duration, or extracorporeal membrane oxygenation support. It was observed that those who had Taussig–Bing anomaly had a higher mortality. Conclusions: Timely treatment have a positive effect on neonatal mortality and morbidity. That’s why all families with prenatal diagnosis of critical CHD should be recommended to have the delivery in a tertiary care hospital. Although it could not be demonstrated in this study, prenatal diagnosis has a potential to improve surgical results especially in countries or cities, which does not have enough resources for transfer and surgical units. Further efforts are needed to improve prenatal screening programmes.

scholarly journals The poor long-term outcomes of owl’s eye pulmonary reconstruction technique after arterial switch operation

2020 ◽  
Vol 31 (1) ◽  
pp. 113-120
Author(s):  
Mehmet Dedemoğlu ◽  
Oktay Korun ◽  
Gültekin Coşkun ◽  
Fatih Özdemir ◽  
Okan Yurdakök ◽  
...  
Keyword(s):  
Arterial Switch Operation ◽  
Reconstruction Technique ◽  
Reconstruction Method ◽  
Long Term Outcomes ◽  
Arterial Switch ◽  
Switch Operation ◽  
Significant Difference ◽  
Autologous Pericardial Patch ◽  
Group 1

Abstract OBJECTIVES This study aims to compare the early- and long-term outcomes of patients who undergo owl’s eye pulmonary artery (PA) reconstruction to those of patients who undergo conventional PA reconstruction. METHODS From January 2016 to January 2017, 64 consecutive patients underwent an arterial switch operation. The patients were divided into 2 groups in terms of neo-PA reconstruction method: 30 patients who underwent neo-PA reconstruction by owl’s eye technique were defined as group 1 and 34 patients who underwent neo-PA reconstruction by the conventional approach were defined as group 2. In the final model, after propensity matching, 23 patients from each group with similar propensity scores were included in the study. RESULTS There was no significant difference between the groups regarding patient characteristics and operative findings. In the early period, the duration of intensive care unit and hospital stays and the rate of mild neo-pulmonary stenosis (neo-PS) were significantly higher in the owl’s eye group (P = 0.04, 0.04 and 0.03). In the late period, the rate of severe neo-PS and reintervention was significantly higher in the owl’s eye group (P = 0.02 and 0.04). Furthermore, the rates of 3-year freedom from pulmonary reintervention and freedom from moderate–severe neo-PS were significantly lower in group 1 (P = 0.04). In addition, the owl’s eye reconstruction was the only factor independently related to moderate–severe neo-PS in the long term (hazard ratios = 11.2, P = 0.02). CONCLUSIONS We have abandoned the owl’s eye method for neo-PA reconstruction of the neo-PA because of serious complications. According to our series and the literature, reconstruction of the neo-PA with an oversized, pantaloon-shaped fresh autologous pericardial patch is still superior to the other techniques.

scholarly journals Two-stage anatomical repair of “simple” transposition of great arteries in neonates with extracardiac perinatal complications

2017 ◽  
Vol 21 (2) ◽  
pp. 43
Author(s):  
O. Yu. Kornoukhov ◽  
V. N. Ilyin ◽  
A. A. Valitova ◽  
V. A. Kryukov
Keyword(s):  
Conflict Of Interest ◽  
Arterial Switch Operation ◽  
Control Group ◽  
Perinatal Complications ◽  
Two Stage ◽  
Transposition Of Great Arteries ◽  
Arterial Switch ◽  
Switch Operation ◽  
Group 2 ◽  
Group 1

<p><strong>Aim.</strong> This study was designed to analyse the results of two-stage arterial switch operation (ASO) of “simple” transposition of great arteries in patients with infection, neurological problems or necrotizing enterocolitis, which preclude neonatal surgery. <br /><strong>Methods.</strong> Transthoracic echocardiography data and outcomes of surgery were investigated in 19 patients (study group; #1) after two-stage ASO and 67 patients (control group; #2) after a single-stage ASO. Age of patients at the first stage was 27 (8–55) days and at the second stage 172 (92–256) days. Patients in group 2 were 7 (2–53) days old. All of them were followed up for 21 (4–49) months (group 1) and 40 (7–79) months (group 2) after arterial switch operation. <br /><strong>Results.</strong> There was no operative mortality at both stages in group 1. The duration of ventilation, length of intensive care unit and hospital stay after surgery were considerably lower in group 1. Actuarial sur-vival and freedom from reoperation at 4 years in group 1 accounted for 100%, while in the con-trol group those indicators at 6 years ran to 98.5% and 94%, respectively. The only difference detected by echocardiography was the aortic valve hinge points Z-score (3.9±1.44 vs 3.1±1.27; p=0.025) and sinuses of Valsalva (3.8±1.41 vs 2.8±1.19; p=0.03), which were higher in the 1st group. There was no aortic regurgitation &gt;1 grade in both groups. <br /><strong>Conclusion.</strong> Two-stage repair of “simple” transposition of great arteries, when it’s necessary to delay arterial switch operation on the clinical grounds, can be performed with excellent clinical outcomes. The tendency of group 1 patients to have a larger neo-aortic root does not appear to bear any clinical significance in mid-term follow-up.</p><p>Received 21 December 2016. Accepted 8 May 2017.</p><p><strong>Funding:</strong> The study had no sponsorship.<br /><strong>Conflict of interest:</strong> The authors declare no conflict of interest. <br /><strong>Author contributions</strong> <br />Study concept and design: Kornoukhov O.Yu., Ilyin V.N.<br />Data collection and analysis: Kornoukhov O.Yu., Valitova A.A., Kryukov V.A. <br />Drafting the article: Kornoukhov O.Yu.<br />Critical revision of the article: Kornoukhov O.Yu., Ilyin V.N. <br />Final approval of the version to be published: Kornoukhov: O.Yu., Ilyin V.N.</p><p> </p>

scholarly journals Is arterial switch operation possible with neonatology-focused intensive care unit modality

2021 ◽  
Vol 29 (2) ◽  
pp. 136-142
Author(s):  
Onur Doyurgan ◽  
Fatih Özdemir ◽  
Osman Akdeniz ◽  
Ahmet Kuddusi İrdem ◽  
Nilüfer Matur Okur ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Arterial Switch Operation ◽  
Length Of Hospital Stay ◽  
Morbidity Rate ◽  
Median Length ◽  
Mortality And Morbidity ◽  
Arterial Switch ◽  
Switch Operation

Background: In this study, we aimed to examine the feasibility of arterial switch operation and its perioperative management with neonatology-focused intensive care modality in a region of Turkey where the birth rate and the number of asylum seekers who had to leave their country due to regional conflicts are high. Methods: Between December 2017 and June 2020, a total of 57 patients (48 males, 9 females; median age: 12.2 days; range, 2 to 50 days) who were diagnosed with transposition of the great arteries in our clinic and underwent arterial switch operation were retrospectively analyzed. All patients were followed by the neonatologist in the neonatal intensive care unit during the preoperative and postoperative period. Results: Thirty-eight (66.7%) patients had intact ventricular septum, 16 (28.1%) had ventricular septal defect, two (3.5%) had coarctation of the aorta, and one (1.7%) had Taussig-Bing anomaly. Coronary artery anomaly was present in 14 (24.5%) patients. The most common complications in the intensive care unit were renal failure requiring peritoneal dialysis in seven (12.3%) patients, supraventricular tachyarrhythmia in six (10.5%) patients, and eight (14%) patients left their chests open. The median length of stay in intensive care unit was 13.8 (range, 9 to 25) days and the median length of hospital stay was 24.5 (range, 16 to 47) days. The overall mortality rate for all patients was 12.3% (n=7). The median follow-up was 8.2 months. A pulmonary valve peak Doppler gradient of ≥36 mmHg was detected in five patients (8.7%) who were followed, and these patients were monitored by providing medical treatment. None of the patients needed reoperation or reintervention. Conclusion: We believe that arterial switch operation, one of the complex neonatal cardiac surgery, can be performed with an acceptable mortality and morbidity rate with the use of neonatology-focused intensive care modality, which is supported by pediatric cardiology and pediatric cardiac surgery.

Two-Stage Arterial Switch Operation: Is Late Ever Too Late?

2002 ◽  
Vol 10 (3) ◽  
pp. 235-239 ◽  
Author(s):  
Howaida O Al Qethamy ◽  
Khawar Aizaz ◽  
Saber AR Aboelnazar ◽  
Samina Hijab ◽  
Yahya Al Faraidi
Keyword(s):  
Septal Defect ◽  
Arterial Switch Operation ◽  
Left Ventricular ◽  
Subaortic Stenosis ◽  
Two Stage ◽  
Actuarial Survival ◽  
Mortality And Morbidity ◽  
Arterial Switch ◽  
Switch Operation

Results of the two-stage arterial switch operation in 49 patients with transposition of the great arteries, performed between January 1995 and September 2000, were reviewed retrospectively. Twenty-one patients had a ventricular septal defect. Anatomical correction was carried out 21.89 ± 9.86 months after pulmonary artery banding, with or without a modified Blalock-Taussig shunt. Hospital mortality was 8% (4 patients). During follow-up of 30.12 ± 14.38 months, there was 1 late death and 1 patient required reoperation for pseudoaneurysm of the ascending aorta. Actuarial survival and freedom from reoperation at 5 years were 90% and 97%, respectively. Late anatomic correction (> 6 months) after the preliminary procedure can be performed with an acceptable mortality and morbidity, but undue delay may lead to left ventricular dysfunction, arrhythmias, and new aortic valve regurgitation or subaortic stenosis.

scholarly journals Stambiųjų kraujagyslių transpozicija ir arterijų sukeitimo operacijos: mūsų patirtis

2007 ◽  
Vol 5 (3) ◽  
pp. 0-0
Author(s):  
Kęstutis Lankutis ◽  
Virgilijus Lebetkevičius ◽  
Virgilijus Tarutis ◽  
Vidmantas Žilinskas ◽  
Sigitas Čibiras ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Arterial Switch Operation ◽  
Pulmonary Stenosis ◽  
Double Outlet Right Ventricle ◽  
University Hospital ◽  
Mortality And Morbidity ◽  
Arterial Switch ◽  
Switch Operation ◽  
Vilnius University ◽  
Underlying Pathology

Kęstutis Lankutis1, Virgilijus Lebetkevičius2, Virgilijus Tarutis2, Vidmantas Žilinskas2, Sigitas Čibiras2, Rita Sudikienė1, Daina Liekienė2, Vytautas Sirvydis21 Vilniaus universiteto ligoninės Santariškių klinikų Širdies chirurgijos centras,Santariškių g. 2, LT-08661 Vilnius2 Vilniaus universiteto Širdies chirurgijos centras,Santariškių g. 2, LT-08661 VilniusEl paštas: [email protected] Įvadas / tikslas Straipsnyje apžvelgiama mūsų techniškai sunkios arterijų sukeitimo operacijos (Jatene) ir stambiųjų kraujagyslių transpozicijos vaikams patirtis. Ligoniai ir metodai Retrospektyviai nagrinėjami 48 ligoniai, kuriems mūsų centre buvo atlikta arterijų sukeitimo operacija. Daugeliu atvejų – tai d-transpozicija ir keturiais atvejais buvo dvigubas ištekėjimas iš dešiniojo skilvelio ir transpozicija (Taussig-Bing tipas). Operacijos atliktos naudojant dirbtinę kraujotaką, kartu atlikta anatomiškai radikali ydos korekcija. Rezultatai Nuo 2002 m. sausio mėn. iki 2007 m. kovo mėn. operuoti 27 kūdikiai. Šiuo laikotarpiu, išmokus operacijos technikos, taikyta standartinė operacijos metodika. Operacinis šios grupės mirtingumas 11%. Dažniausia mirties priežastis – miokardo išemija dėl nesėkmingos vainikinių arterijų perkėlimo procedūros, esant nepalankiai anatominei jų padėčiai. Dėl pooperacinių vėlyvųjų komplikacijų stebėti keturi ligoniai, kuriems buvo įvairaus laipsnio plaučių arterijos stenozė. Du ligoniai dėl šios komplikacijos operuoti. Išvados Arterijų sukeitimo operacijos kaip fiziologiškiausios yra pirmo pasirinkimo vaikams, kuriems yra stambiųjų kraujagyslių transpozicija. Pastaraisiais metais pasiekta gana gerų ir priimtinų mirtingumo ir kokybės rodiklių. Pagrindiniai žodžiai: arterijų sukeitimo operacija, Jatene operacija, pagrindinių arterijų transpozicija Our experience in arterial switch operation of the great arteries Kęstutis Lankutis1, Virgilijus Lebetkevičius2, Virgilijus Tarutis2, Vidmantas Žilinskas2, Sigitas Čibiras2, Rita Sudikienė1, Daina Liekienė2, Vytautas Sirvydis21 Cardiac Surgery Centre of Vilnius University Hospital „Santariškių klinikos“,Santariškių str. 2, LT-08661 Vilnius2 Cardiac Surgery Centre, Vilnius University, Santariškių str. 2, LT-08661 VilniusE-mail: [email protected] Background / objective A review of our experience in the technically demanding arterial switch operation (Jatene) in transposition of the great arteries in children. Patients and methods 48 children who underwent an arterial switch operation at our Centre were retrospectively reviewed. The underlying pathology was d-transposition of the great arteries and a double outlet right ventricle of Taussig-Bing transposition type in four cases. The operation was performed in cardiopulmonary bypass for anatomically repair of the transposition. Results From January 2002 – March 2007, 27 infants underwent an arterial switch operation. Operative mortality in this period was 11%, in most cases from myocardial ischemia following unsuccessful transfer of a dangerous pattern of coronary arteries. Postoperative morbidity occurred in four patients who presented various degrees of pulmonary stenosis artery. Two patients required reoperation. Conclusions The arterial switch operation is considered to be a procedure of choice for correction of transposition of the great arteries. The operation involves acceptable mortality and morbidity. Key words: arterial switch operation, Jatene operation, transposition of the great arteries

Alternative pulmonary artery reconstruction technique in the arterial switch operation

2021 ◽  
Author(s):  
Hisayuki Hongu ◽  
Masaaki Yamagishi ◽  
Yoshinobu Maeda ◽  
Keiichi Itatani ◽  
Masatoshi Shimada ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Arterial Switch Operation ◽  
Late Complication ◽  
Late Complications ◽  
Reconstruction Technique ◽  
Reconstruction Method ◽  
Arterial Switch ◽  
Switch Operation ◽  
Longitudinal Extension

Abstract OBJECTIVES Late complications of arterial switch operations (ASO) for transposition of the great arteries, such as neo-pulmonary artery (PA) stenosis and/or neoaortic regurgitation, have been reported. We developed an alternative reconstruction method called the longitudinal extension (LE) method to prevent PA bifurcation stenosis (PABS). METHODS We identified 48 patients diagnosed with transposition of the great arteries and performed ASO using the Lecompte manoeuvre for neo-PA reconstruction. In 9 consecutive patients (from 2014), the LE method was performed (LE). Before 2014, conventional techniques were performed in 39 patients (C). The median body weight and age in the LE and C groups were 3.0 and 3.1 kg and 12 and 26 days, respectively. In the LE group, 1 patient underwent bilateral PA banding before ASO. In C, PA banding and arch repair were performed in 1 patient each. Patients who received concomitant procedures were included. RESULTS The median follow-up in LE and C groups was 1.9 and 10.1 years, respectively. Early mortality/late death was not found in group LE and in 1 patient in group C. Only 1 case required ascending aorta sliding plasty in LE, and 8 patients needed PA augmentation for PABS in C. The median velocity of right/left PA was measured as 1.6/1.9 m/s in LE and 2.1/2.3 m/s in C, so it showed a lower value in LE. CONCLUSIONS Excellent mid-term results were obtained with the LE method. It was considered a useful procedure in preventing PABS, which is a primary late complication of ASO. Further follow-up and investigations are needed.

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