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Title: Immediate and intermediate term outcome of arterial switch operation in transposition of great arteries
Authors: Debopriyo Mondal
Issue Date: Dec-2019
Publisher: SCTIMST
Abstract: Background: Dextro Transposition of Great Arteries (D TGA) accounts for 5 – 7% of all congenital heart defects (CHD) with a prevalence of 0. 2 per 1000 live births and male predominance. The arterial switch operation (ASO) has replaced the old atrial switch procedures developed by Senning and Mustard in the management of d-transposition of the great arteries (D-TGA) for the last 40 years after Jatene performed the first successful ASO in 1975. Since then survival rates have improved over years with refinement of surgical techniques and improved medical management. Currently, most treated patients live to adulthood, with a 20-year survival of about 90% as reported from various international centres. Operative mortality for simple TGA is reported in the range of 2- 7%, compared to 15% as found in earlier studies. Risk factors for operative mortality includes the presence of a ventricular septal defect, older age at repair, coexisting anomalies, and anomalous coronary patterns. Aims and Objectives: Current study is aimed at finding out risk factors of early mortality and intermediate term outcomes of children undergoing ASO. Indian data regarding factors affecting mortality rates and follow up data are scarce, and hence this study. Materials and Methods: It was a retrospective observational study with cross sectional follow up which included patients with simple TGA with or without VSD who underwent Arterial switch operation between 1 st January 2008 to 30 June 2018 in SCTIMST. Bsaseline demographic data, peri operative parameters were collected. In the immediate post operative period arrhythmias, ventricular dysfunction, Coronary flow and deaths, and in the intermediate term neo Aortic incompetence, Neo pulmonary stenosis , ventricular dysfunction/Heart failure, arrhythmia, and the incidence of re intervention (s) were looked into. Results: Most patients were male babies. BAS was done in 149 out of 168 children (88. 69%). Regressed left ventricle was found in 17 children (10. 24%). Mean age at surgery for patients with normal LV function was 26. 13+/- 21. 76 days whereas in patients with regressed LV it was 72. 64 +/-101. 71 days. 22 patients underwent ASO +VSD closure, 2 underwent ASD closure and 1 patient underwent PDA ligation. 34 patients underwent ASO after 1 month of life,out of which 5 patients died in the immediate post operative period Among patients who were surviving 37. 5 % were free from neo aortic regurgitation, and 12. 5 % free from neo pulmonary regurgitation. Mild neo AR was seen in 34. 52% and more than mild in 16%. The most common artery pattern was 1LCX2R in 77. 38%. Early arrhythmia occurred in 8 patients (4. 76%). There were probable 5 SCD (likely arrhythmic events). Early mortality rate was 7. 1 % and the overall mortality 10. 68 %. Sepsis was seen in 10 out of 12 patients who died in the early post operative period. On follow up 14 patients had developed supravalvar pulmonary stenosis. 6 children had only mild PS, 8 had severe supravalvar PS. Multivariate regression analysis revealed that ionotrope duration and Left ventricular dysfunction were independently associated with early mortality. Coronary pattern was not associated with mortality. Actuarial survival was 89. 29% at median follow up of 43. 63 months. Freedom from re interventions was 91. 82 % at the end of 5 years. Conclusions: Coronary anatomy, Birth weight did not affect the outcome of our cohort of 168 children who underwent ASO at our centre. Sepsis was the commonest cause of in – hospital death in 10 out of 12 children. Predictors of mortality were left ventricular function and ionotrope duration in multivariate analysis
Appears in Collections:Cardiology

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