Abstract 18301: Intra-operative Left Coronary Doppler Profile Independently Predicts Need for Ecmo or Late Revision After Arterial Switch
Objective: We hypothesized that intraoperative coronary Doppler profiles after button implantation would help predict survival and morbidity after arterial switch.
Methods: Children (N=319) undergoing arterial switch (2000-2012; TGA 190, TGA-VSD 95, TGA-VSD-PS 10, Taussig-Bing 14, others 10) underwent intraoperative echocardiographic assessment of coronary buttons. Studies were blindly reviewed to delineate Doppler gradient, peak flow velocity, velocity-time integral (VTI) and late diastolic flow reversal, which were explored as predictors of death, ICU morbidity and need for late coronary revision via parametric risk-adjusted regression and bootstrap reliability.
Results: Outcomes included: death=9 (3%), ECMO=13 (4%), surgical coronary revision=9 (3%). Higher left button Doppler values were predictors of chest open duration, post-op JET, need for revision or ECMO. Mean left button gradient was the most reliable - table. Right button Doppler values were not strong predictors of morbidity.
Higher left Doppler gradients confer disproportionate impact - figure. Mean gradient ≥ 1.5 had late revision risk 27%, versus 1.6% for < 1.5 (P=.0016).
Intraoperative strategies to improve button geometry included release of fascia (16, 5%) or button revision (9, 3%). Such strategies reduced gradients, velocities and VTI (P between .004 and .03). Left Doppler values retained their predictive value even in 296 (93%) children who had no such coronary manipulation - table.
Conclusions: Aiming for mean left coronary gradient < 1.5-2 and peak <4 mmHg through routine Doppler assessment will help lower risk of ECMO and late coronary problems.
Author Disclosures: F.H. Halvorsen: None. D. Yim: None. L. Nield: None. C.A. Caldarone: Ownership Interest; Modest; Cellaegis inc, ON. G.S. Van Arsdell: Ownership Interest; Modest; Cellaegis Inc. E. Pham-Hung: None. A. Duong: None. M. Gritti: None. E.J. Hickey: None.
- © 2015 by American Heart Association, Inc.