Abstract 16518: Surgical Timing for Arterial Switch Operation: Does Post-Natal Maturation Matter?
Introduction: Possibility of late correction of Transposition of Great Arteries (TGA) was well explored. However, little information exists about optimal timing for Arterial Switch Operation (ASO) with regard to newborn maturation.
Material and methods: A retrospective review was performed of all neonatal ASO for TGA with intact ventricular septum, type I coronary pattern, normal arch from 1983 to 2013 (period A 1983-1998 and B: 1999-2013). Uni and multivariate analysis determined influence of age at procedure on “prolonged ICU stay” (>3rd quartile) and combined endpoint of “30 day mortality or ECMO support”. Weight, gender, balloon atrial septostomy (BAS), antenatal diagnosis, prostaglandin use, preoperative O2 saturation, surgical era were analyzed as cofactor.
Results: 901 neonates met inclusion criteria: median age 9.0days [1-30] and weight 3260g [1600-5360]. BAS was performed in 757, 584 were on prostaglandin, 154 were prenatal diagnosis. Overall mortality was 3.5% (n=32). Only prostaglandin resulted in significant reduction of mortality/ECMO in the entire cohort (univariate p=0.01, multivariate OR 0.41 [0.21-0.81], p=0.01) but not in period B. In each period, other factor did not influence mortality/ECMO. Higher weight significantly decreased rate of prolonged ICU stay for both periods: univariate, p=0.01 and multivariate (OR 0.91 [0.87-0.95] p=0.01 per 100g increased weight). Age favourably influenced rate of prolonged ICU only in period A (univariate, p=0.02). In period B, prenatal diagnosis significantly increased rate of prolonged ICU, OR 1.8 [1.1-3.2], p=0.05. BAS, saturation did not influence ICU stay.
Conclusion: In ASO for simple TGA, early outcome is not influenced by age at surgery. Higher weight is associated with significant reduction of morbidity. Prostaglandins played a key role for improved early outcomes while preoperative saturation had no influence. In recent surgical era, antenatal diagnosis appeared not protective.
- © 2013 by American Heart Association, Inc.