Follow-up Research For Transposition Of The Great Arteries With Intact Ventricular Septum After Arterial Switch Operation

Objective:The aim of this report was to study the outcomes and relevant factors after arterial switch operation for transposition of the great arteries with intact ventricular septum.Methods:Between June 2005 and December 2010,53 patients with TGA/IVS underwent ASO were admitted into our study. All case histories were reviewed such as operative age, weight, gender, diagnosis, coronary artery type, average cardiopulmonary bypass time, aortic across-clamp time, ventilation time, duration of cardiac intensive care unit stay and hospital stay after surgery, perioperative complications and managements, early mortality, follow-up data and so on. The patients were divided into 2 groups according to operative age. Group A included 29 patients (54.7%) who were younger than 3 weeks, they all received primary ASO; Group B consisted of 24 patients older than 3 weeks, they were divided into two subgroups,18 patients underwent primary ASO (group B1) and 6 patients received rapid two-stage ASO (group B2).Results:53 patients with TGA/IVS underwent ASO between June 2005 and December 2010. Group A included 29 patients younger than 3 weeks with median age of 10.7±4.3 days (range from 2 to 21 days), median weight of 3.3±1.2kg(range from 2.7 to 4.6kg), they all received primary ASO; Group B included 24 patients older than 3 weeks with median age of 153.2±340.6 days (range from 25 to 1469days), median weight 5.2±4.1kg (range from 2.7 to 12.5kg).6 patients suffered from variant coronary arteries:2cases with 1LAD,R,2Cx; 1case with 1LAD,2R,Cx; 2cases with 1LAD,Cx,R; 1case with intramural coronary.3 patients (5.67%) died during hospital stay postoperative, two of them with variant coronary artery. There was no statistical difference between old group and young group about early mortality after primary ASO. The average CPB time (P=0.044), ventilation time (P=0.030), hospital stay after surgery (P=0.026) showed statistical differences, it also showed higher incidence of perioperative complications such as low cardiac output syndrome, renal failure with peritoneal dialysis, infection, pulmonary atelectasis and so on among patients older than 3 weeks. We didn't find statistical difference between primary ASO and rapid two-stage ASO about perioperative data in patients older than 3 weeks. One patient in group B1 who was older than 6 months and underwent primary ASO, required postoperative extracorporeal membrane oxygenation (ECMO) support for low cardiac output syndrome. Early and mid-term outcomes about left ventricular function and growth among groups were compared and there was no significant difference.Conclusion Patients older than 3 weeks could also accept primary ASO if LVP/RVP was above 0.65 preoperative. There was no statistical difference on early mortality between young group and old group, but old group recovered slower than young group, at the same time it showed higher morbidity on perioperative complications, even required ECMO support. Patients with LV degeneration could subjected to LVT first in order to decrease the incidence of low cardiac output syndrome and application of ECMO. There was no significant difference about LV function and growth during early and mid-term Follow-up. Operative age of primary ASO for TGA/IVS can be postponed, but early diagnosis, early treatment could improve perioperative prognosis.