Primary arterial switch operation in children presenting late with d-transposition of great arteries and intact ventricular septum. When is it too late for a primary arterial switch operation?

被引:43
作者
Bisoi, Akshay Kumar [1 ]
Sharma, Pranav [1 ]
Chauhan, Sandeep [1 ]
Reddy, Srikrishna Modugula [1 ]
Das, Shambhunath [1 ]
Saxena, Anita [1 ]
Kothari, Shyam Sunder [1 ]
机构
[1] All India Inst Med Sci, Dept Cardiothorac & Vasc Surg, Ctr Cardiothorac, New Delhi 110029, India
关键词
Great vessel transposition; Arterial switch operation; Extracorporeal membrane oxygenation; OUTFLOW TRACT OBSTRUCTION; REPAIR; ECHOCARDIOGRAPHY; HEART; OLDER;
D O I
10.1016/j.ejcts.2010.03.037
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: The surgical management of infants older than 2 weeks with d-transposition of great arteries and intact ventricular septum (IVS) is a matter of debate. Some studies have presented good results of primary arterial switch operation (ASO) in these children. The aim of this study was to assess the surgical outcome of the primary ASO in children with d-transposition of great arteries and IVS presenting beyond 6 weeks of age. Methods: The clinical records of the children (more than 6 weeks age) with d-transposition of great arteries and IVS, who underwent primary ASO at our institute between January 2003 and June 2009 were reviewed. Left ventricular geometry and interventricular septal motion on the transthoracic cross-sectional echocardiogram were taken to assess the left ventricle preparedness. Results: Fifty-five children (age ranging from 42 days to 9 years) with d-transposition of great arteries and IVS underwent primary ASO. The mean cardiopulmonary bypass time was 94.7 +/- 21.3 min, while mean aortic cross-clamp time was 53.2 +/- 8.1 min. Seven (13%) of these children died during their hospital stay. The children who had severely regressed left ventricle (banana-shaped left ventricular geometry) were operated with integrated extra corporeal membrane oxygenation cardiopulmonary bypass (ECMO-CPB) circuit for left ventricular re-training. The children with regressed left ventricle required longer ventilatory time and inotropic support. Recovery of left ventricular geometry has taken 1-6 months depending on age at surgery. Conclusions: The children older than 6 weeks with d-transposition of great arteries and IVS can benefit from primary ASO with acceptable results. However, the need for mechanical support in some of the older patients may limit the widespread adoption of such a strategy. (C) 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
引用
收藏
页码:707 / 713
页数:7
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