Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-28T00:55:46.422Z Has data issue: false hasContentIssue false
  • English
  • Français

Transposition of the great vessels and intact ventricular septum: is there an age limit for the arterial switch? Personal experience and review of the literature

Published online by Cambridge University Press:  29 June 2020

Zied Daoud Open the ORCID record for Zied Daoud [Opens in a new window] ,
Halkawt Ali Nuri ,
Ambra Miette  and
Giuseppe Pomè
Zied Daoud*
Affiliation:
Istituto Giannina Gaslini Istituto Pediatrico di Ricovero e Cura a Carattere Scientifico, Cardiovascular Surgery, Genova, Liguria, Italy
Halkawt Ali Nuri
Affiliation:
Istituto Giannina Gaslini Istituto Pediatrico di Ricovero e Cura a Carattere Scientifico, Cardiovascular Surgery, Genova, Liguria, Italy
Ambra Miette
Affiliation:
Istituto Giannina Gaslini Istituto Pediatrico di Ricovero e Cura a Carattere Scientifico, Cardiovascular Surgery, Genova, Liguria, Italy
Giuseppe Pomè
Affiliation:
Istituto Giannina Gaslini Istituto Pediatrico di Ricovero e Cura a Carattere Scientifico, Cardiovascular Surgery, Genova, Liguria, Italy
*
Author for correspondence: Zied Daoud, Cardiac surgery department, Via Gerolamo Gaslini, 5, 16147GenovaGE, Italy. Tel: +00 33 6 34 38 33 59; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Prognosis of the transposition of the great arteries has completely changed since the introduction of the arterial switch. Time limit to perform this intervention is still controversial. The aim of this study is to demonstrate the early and late outcome of primary arterial switch operation beyond the age of months.

Methods:

We included all patients with the diagnosis of transposition of the great arteries with intact ventricular septum beyond the age of 8 weeks who underwent primary arterial switch operation. The procedures were performed by the same surgeon, in two different institutes. Patients who had transposition of the great arteries and associated anomalies (except atrial septal defect and persistent arterial duct) were excluded. Ventricular shape, geometry, and mass were not considered during the decision on procedure type.

Results:

In the study, 11 patients with the diagnosis of simple d-transposition of the great arteries beyond 8 weeks were undergone primary arterial switch operation with a mean age of 90.63 days (60–137 days), and 7 patients had a Rashkind procedure. All patients had squashed left ventricle shape with preserved function. The sternum was left open in 10 patients. Extracorporeal membrane oxygenation support was necessary in 45.45% of cases. The mean mechanical ventilation time was 7.27 days (1–16 days). No mortality was recorded until now. Post-operatory left ventricular function was preserved in 90.9% of the patients. Only one patient had mild myocardial dysfunction at the time of discharge.

Conclusions:

Primary arterial switch procedure can still be the best surgical option in patients with the diagnosis of transposition of the great arteries with intact ventricular septum beyond 8 weeks of age, providing that mechanical circulatory support and an expert cardiac intensive care unit service are available.

Keywords

Transposition of the great vesselsArterial Switch OperationLeft vuntricular dysfunctionExtracorporeal Membrane Oxygenation
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 7 , July 2020 , pp. 1012 - 1017
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Benscoter, AL, Ryan, A, Tweddell, JS.57 – transposition of the great arteries and the arterial switch operation. In: Ungerleider, RM, Meliones, JN, Nelson McMillan, K, Cooper, DS, Jacobs, JP (eds). Critical Heart Disease in Infants and Children, 3rd edn. Elsevier, Philadelphia, 2019: 683–693.e2.CrossRefGoogle Scholar
Anderson, BR, Ciarleglio, AJ, Hayes, DA, et al.Earlier arterial switch operation improves outcomes and reduces costs for neonates with transposition of the great arteries. J Am Coll Cardiol 2014; 63: 481–487.CrossRefGoogle ScholarPubMed
Rito, ML, Basile, DP, Micheletti, A, et al.OC64 results of primary arterial switch operation after 21 days of age for transposition of great arteries with intact ventricular septum. J Cardiovasc Med 2018; 19: e7.CrossRefGoogle Scholar
Foran, JP, Sullivan, ID, Elliott, MJ, deLeval MR primary arterial switch operation for transposition of the great arteries with intact ventricular septum in infants older than 21 days. J Am Coll Cardiol 1998; 31: 883–889.10.1016/S0735-1097(98)00012-6CrossRefGoogle Scholar
Kang, N, de Leval, MR, Elliott, M, et al.Extending the boundaries of the primary arterial switch operation in patients with transposition of the great arteries and intact ventricular septum. Circulation 2004; 110 (11 Suppl 1): II123–II127.CrossRefGoogle ScholarPubMed
Sarris, GE, Chatzis, AC, Giannopoulos, NM, et al.The arterial switch operation in Europe for transposition of the great arteries: a multi-institutional study from the European congenital heart surgeons association. J Thorac Cardiovasc Surg 2006; 132: 633–639.CrossRefGoogle ScholarPubMed
Ismail, SR, Kabbani, MS, Najm, HK, Abusuliman, RM, Elbarbary M early outcome for the primary arterial switch operation beyond the age of 3 weeks. Pediatr Cardiol 2010; 31: 663–667.CrossRefGoogle ScholarPubMed
Edwin, F, Kinsley, RH, Brink, J, et al.Late primary arterial switch for transposition of the great arteries with intact ventricular septum in an African population. World J Pediatr Congenit Heart Surg 2011; 2: 237–242.CrossRefGoogle Scholar
Fricke, TA, d’Udekem, Y, Richardson, M, et al.Outcomes of the arterial switch operation for transposition of the great arteries: 25 years of experience. Ann Thorac Surg 2012; 94: 139–145.CrossRefGoogle Scholar
Ma, K, Hua, Z, Yang, K, et al.Arterial switch for transposed great vessels with intact ventricular septum beyond one month of age. Ann Thorac Surg 2014; 97: 189–195.CrossRefGoogle ScholarPubMed
Bisoi, AK, Ahmed, T, Malankar, DP, et al.Midterm outcome of primary arterial switch operation beyond six weeks of life in children with transposition of great arteries and intact ventricular septum. World J Pediatr Congenit Heart Surg 2014; 5: 219–225.CrossRefGoogle ScholarPubMed
Yildiz, O, Ozturk, E, Onan, S, et al.Late primary arterial switch operation in patients with transposition of great arteries and intact ventricular septum. Turk Gogus Kalp Damar Cerrahisi Dergisi-Turk J Thorac Cardiovasc Surg 2016; 24: 415–421.CrossRefGoogle Scholar
Iyer, KS, Sharma, R, Kumar, K, et al.Serial echocardiography for decision making in rapid two-stage arterial switch operation. Ann Thorac Surg 1995; 60: 658–664.CrossRefGoogle ScholarPubMed
Bisoi, AK, Chauhan, S, Khanzode, SD, et al.D-Transposition of great vessels with intact ventricular septum presenting at 3–8 weeks: Should all go for rapid two stage arterial switch or primary arterial switch? Indian J Thorac Cardiovasc Surg 2006; 22: 5–9.CrossRefGoogle Scholar
Corno, AE, Hurni, M, Payot, M, et al.Adequate left ventricular preparation allows for arterial switch despite late referral. Cardiol Young 2003; 13: 49–52.CrossRefGoogle ScholarPubMed
Hutter, PA, Kreb, DL, Mantel, SF, et al.Twenty-five years’ experience with the arterial switch operation. J Thorac Cardiovasc Surg 2002; 124: 790–797.CrossRefGoogle ScholarPubMed
Helvind, MH, McCarthy, JF, Imamura, M, et al.Ventriculo-arterial discordance: switching the morphologically left ventricle into the systemic circulation after 3 months of age. Eur J Cardiothorac Surg 1998; 14: 173–178.CrossRefGoogle ScholarPubMed
Lacour-Gayet, F.Complexity stratification of the arterial switch operation: a second learning curve. Cardiol Young 2012; 22: 739–744.CrossRefGoogle ScholarPubMed
Wernovsky, G, Mayer, JEJ, Jonas, RA, et al.Factors influencing early and late outcome of the arterial switch operation for transposition of the great arteries. J Thorac Cardiovasc Surg 1995; 109: 289–301; discussion 301–302.CrossRefGoogle ScholarPubMed
Sarris, GGC, Balmer, SC, Bonou, GP, et al.Clinical guidelines for the management of patients with transposition of the great arteries with intact ventricular septum. Eur J Cardiothorac Surg 2017; 51: e1–e32.CrossRefGoogle Scholar