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.

scholarly journals Manajemen Perioperatif Operasi Arterial Switch pada Transposition of The Great Arteries with Intact Ventricular Septum

2020 ◽  
Vol 12 (2) ◽  
pp. 11-22
Author(s):  
Dian Kesumarini ◽  
Herdono Poernomo
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Myocardial Protection ◽  
Septal Defect ◽  
Arterial Switch Operation ◽  
Ductus Arteriosus ◽  
Intact Ventricular Septum ◽  
Arterial Switch ◽  
Switch Operation ◽  
Patent Ductus

Latar belakang: Penyakit jantung bawaan (PJB) berkontribusi terhadap hampir sepertiga dari kelainan kongenital secara keseluruhan. Transposition of the great arteries (d-TGA) adalah satu kelainan jantung bawaan (PJB) yang kompleks. Tindakan arterial switch operation (ASO) menjadi pilihan koreksi pada kasus TGA. Tindakan ini mempunyai risiko morbiditas dan mortalitas yang cukup tinggi.Kasus: Bayi berusia 42 hari dengan berat badan 3100 gram dirujuk ke Rumah Sakit Jantung dan Pembuluh Darah (RSJPD) Harapan Kita karena kelainan jantung. Pasien dilakukan diagnosik ekokardiografi dan didapatkan TGA dengan septum ventrikular yang intak (TGA-IVS), atrium septal defect (ASD) sekundum L-R shunt, dan patent ductus arteriosus (PDA). Prosedur pembedahan meliputi ASO menggunakan manuver Le Compte, pemotongan PDA, ASD ditutup sebagian dan disisakan 3mm. Durasi cardiopulmonary bypass (CPB) 136 menit dengan cross clamp 85 menit, diberikan tranfusi PRC, FFP, dan TC, lalu dipindahkan ke intensive care unit (ICU) dengan support adrenalin 0.05 mcg/kg/menit dan milrinone 0.375 mcg/kg/menit. Ekstubasi dilakukan 72 jam pascaoperasi.Pembahasan: Operasi arterial switch merupakan tindakan berisiko tinggi, dengan angka kematian dan morbiditas yang tinggi. Konsiderasi perianestesia pada pasien TGA ini di antaranya tatalaksana preanestesi, manajemen selama operasi, topangan hemodinamik, aritmia yang diakibatkan masalah pembuluh darah koroner, dan penilaian ekokardiografi epikardial pascaoperasi. Manajemen pascaoperasi penting untuk mengantisipasi efek dari CPB yang berpengaruh pada miokardium, sindroma curah jantung rendah, risiko infeksi, dan komplikasi lain yang sering terjadi pada infant setelah pembedahan ini.Kesimpulan: Manajemen preoperatif dengan mengenali faktor risiko, tatalaksana anestesia intraoperatif, myocardial protection, serta perawatan komprehensif pascaoperasi di ICU sangat menentukan outcomepasien yang menjalani prosedur ini. 

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

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 Five years experiences in diagnosis and management of jejuno-ileal atresia in Kanti children’s hospital

2020 ◽  
Vol 23 (2) ◽  
pp. 4-8
Author(s):  
Anupama Basnet ◽  
Bijay Thapa ◽  
Prativa Dhoubadel ◽  
Anuj Kayastha
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Ventilatory Support ◽  
Morbidity Rate ◽  
Surgical Intensive Care Unit ◽  
Ileal Atresia ◽  
Surgical Intensive Care ◽  
Mortality And Morbidity ◽  
Jejunoileal Atresia ◽  
End To End

Introduction: Jejuno-ileal atresia is a major cause of neonatal intestinal obstruction. The aim of this study is to evaluate the incidence, clinical presentation, management, and outcome of jejunoileal atresia at our institute over a period of five years. Methods: The medical records of the patients with the diagnosis of jejunoileal atresia during a period of five years (April 2014 to April 2019) were obtained from the hospital record section and surgical intensive care unit, and were reviewed and analyzed. Results: There were 61 cases of jejunoileal atresia among 144 cases of intestinal atresia. Twenty-nine (47.5%) of them were male. Laparotomy with resection of atretic part with anti-mesenteric tapering enteroplasty and end to end anastomosis was done in 15, and resection without tapering enteroplasty with end to end anastomosis was done in 39 patients. Thirty-eight patients (62.3%) were discharged while Twenty-three (37.7%) cases were lost to mortality. Conclusions: Although the mortality and morbidity rate are high in jejunoileal atresia, early diagnosis, improvement in surgical technique, modern ventilatory support and advanced in intensive care unit has led to the significant increase in the survival rate.

Risk Factors for Adverse Postoperative Outcomes in Children Presenting for Cardiac Surgery with Upper Respiratory Tract Infections

2003 ◽  
Vol 98 (3) ◽  
pp. 628-632 ◽  
Author(s):  
Shobha Malviya ◽  
Terri Voepel-Lewis ◽  
Monica Siewert ◽  
Uma A. Pandit ◽  
Lori Q. Riegger ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Postoperative Complications ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Healthy Children ◽  
Upper Respiratory Tract ◽  
Upper Respiratory ◽  
Tract Infections

Background Otherwise healthy children who present for elective surgery with an upper respiratory infection (URI) may be at risk for perioperative respiratory complications. This risk may be increased in children with congenital heart disease who undergo cardiac surgery while harboring a URI because of their compromised cardiopulmonary status. Therefore, this study was designed to determine the incidence of peri- and postoperative complications in children undergoing cardiac surgery while harboring a URI. Methods The study population consisted of 713 children scheduled to undergo cardiac surgery. Of these, 96 had symptoms of URI, and 617 were asymptomatic. Children were followed prospectively from induction of anesthesia to discharge from the hospital to determine the incidence of postoperative respiratory, cardiovascular, neurologic, and surgical adverse events. Duration of postoperative ventilation, time in the intensive care unit (ICU), and length of hospital stay were also recorded. Results Children with URIs had a significantly higher incidence of respiratory and multiple postoperative complications than children with no URIs (29.2 vs 17.3% and 25 vs 10.3%, respectively; P< 0.01) and a higher incidence of postoperative bacterial infections (5.2 vs 1.0%; P= 0.01). Furthermore, logistic regression indicated that the presence of a URI was an independent risk factor for multiple postoperative complications and postoperative infections in children undergoing open heart surgery. Children with URIs also stayed longer in the intensive care unit than children with no URIs (75.9 +/- 89.8 h vs 57.7 +/- 63.8, respectively; P< 0.01). However, the overall length of hospital stay was not significantly different (8.4 vs 7.8 days, URI vs non-URI groups; P> 0.05). Conclusions The presence of a URI was predictive of postoperative infection and multiple complications in children presenting for cardiac surgery. Despite this, the presence of a URI does not appear to affect the patient's overall length of hospital stay nor the development of long-term sequelae.

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 Case report: double lung en bloc procurement from a donor after arterial switch operation

2021 ◽  
Vol 31 (8) ◽  
pp. 1238-1240
Author(s):  
Yuriy Stukov ◽  
Edward D. Staples ◽  
Jeffrey P. Jacobs ◽  
Giles J. Peek ◽  
Tiago N. Machuca ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Case Report ◽  
Arterial Switch Operation ◽  
Organ Donors ◽  
En Bloc ◽  
Arterial Switch ◽  
Switch Operation ◽  
Unmet Demand ◽  
En Bloc Procurement ◽  
Thoracic Organ

AbstractThe growing unmet demand for suitable organ donors increases each year. Despite relative contraindications for thoracic organ donation after previous cardiac surgery, experienced programmes and surgeons can successfully utilise the lungs from select donors who have undergone prior cardiac surgery. This is the first reported case of double lung en bloc procurement from a donor who had a previous arterial switch operation as an infant.

Functional outcomes after neonatal open cardiac surgery: comparison of survivors of the Norwood staged procedure and the arterial switch operation

2010 ◽  
Vol 20 (06) ◽  
pp. 668-675 ◽  
Author(s):  
Gwen Y. Alton ◽  
Gwen R. Rempel ◽  
Charlene M. T. Robertson ◽  
Christine V. Newburn-Cook ◽  
Colleen M. Norris
Keyword(s):  
Cardiac Surgery ◽  
Functional Outcomes ◽  
Arterial Switch Operation ◽  
Arterial Switch ◽  
Switch Operation
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