Early Prognosis Of Switch Operation In Children With Complete Transposition Of The Great Arteries

Part ?:Characteristics of children with TGA and risk factors of postoperative death after Switch operationObjectiveTo analyze the characteristics and early results of patients who underwent Switch operation in provincial medical center and the main factors affecting the early prognosis.MethodsWe retrospectively collected the medical records of patients with TGA who underwent Switch operation in Shandong Provincial Hospital from January 2014 to December 2019,sorted out their personal information and data on preoperative treatment,echocardiography reports,age and weight at the time of surgery,surgical method,location of large arteries,coronary artery pattern,intraoperative operation and time of CPB and AC,delayed sternal closure,retention in ICU and duration of mechanical ventilation,total length of hospital stay,etc.ResultsA total of 87 patients were collected,mainly from the local area and three southern cities.The proportion of rural patients(64.4%)and male patients(73.6%)was relatively high.The second child in the family accounted for a large proportion(59.8%)of patients.The proportion of prenatal diagnoses was low(26.4%),and most of them were among urban patients.Fifty-six(64.4%)patients were TGA-IVS,84 patients(96.6%)combined with ASD or PFO,and 69 patients(79.3%)combined with PDA.The main coronary artery pattern was the conventional pattern(1LAD,Cx;2R.72.4%).Before operation,14 patients(16.1%)were closely monitored in ICU,19 patients(21.8%)required mechanical ventilation(MV),7 patients requireed rescue or emergency operation.Thirteen patients underwent surgery within one week after birth,34 patients aged 7-14 days,and 40 patients aged more than 14 days.The weight of 11 patients was less than 3kg.After the operation,PFO was preserved in 65.5%of patients,and sternum closure was delayed in 72.4%of patients.Among the 87 patients,9 died after the operation.Premature delivery,preoperative MV,preoperative ICU admission,preoperative rescue history or emergency operation,age<7 days and weight<3 kg at the time of operation were statistically significant risk factors for postoperative death.The mortality rates for female,urban patients,cesarean section,first child in the family,prenatal diagnosis,TGA-IVS and coronary artery pattern abnormality were higher than those for the corresponding factors,but the differences were not statistically significant.The ROC curve of age at surgery showed that the area under the curve for judging patient survival was 0.864(P<0.001),the Jorden index was 0.705,and the cut-off value was 8.5 days.The ROC curve of weight at surgery showed that the area under the curve for judging patient survival was 0.880(P<0.001),the Jorden index was 0.660,and the cut-off value was 3.05 kg.ConclutionThe sources of TGA patients in provincial medical center showed regional characteristics.Combined VSD and coronary artery pattern had no significant influence on surgical mortality.Premature birth,preoperative mechanical ventilation,intensive care,history of rescue or emergency surgery,age less than 7 days,weight less than 3 kg were risk factors for postoperative death of ASO.Part ?:Prognosis and risk factors in children with TGA diagnosed prenatallyObjectiveTo analyze the individual differences and early prognosis in children with TGA diagnosed prenatally.MethodsThe inpatient medical records of fetal diagnosed TGA children in our hospital from January 2014 to December 2019 were retrospectively collected,and the social information of the children and their mothers,pregnancy status,echocardiography report,preoperative intervention,surgical records,postoperative treatment,etc.,were recorded in detail.ResultsA total of 28 patients were collected.The mothers were 20-38 years old,mostly 3135 years old,and the gestational age at diagnosis was 22-35 weeks.Twenty-one patients were delivered in our hospital,and 7 patients were referred from other hospitals.The babies were born with a weight of 3.3±0.5 kg and a body length of 48.3±2.6 cm.Urban,male,cesarean section,full term delivery,and the first child in the family had a higher proportion.Three patients died before surgery,and 2 patients gave up treatment because of critically illness before surgery.All of them were full term at delivery,and all of them had TGA-IVS and lacked an effective blood shunt at the foramen ovale and ductus arteriosus.The total width of intracardiac blood shunt of them(0.50±0.11 cm)was significantly smaller than that of the patients who underwent surgery(1.08±0.49 cm),the difference was statistically significant(P=0.016).Twenty-three children underwent Switch opeartion with an age of 16.3±23.1 d and weight of 3.4±0.6 kg,and 4 died after surgery:three of them were premature and weighed less than 3kg at surgery.All the mothers of the patients who died had adverse pregnancy factors,and one patient was a twin.Among the patients who died,2 patients had TGA-VSD and 2 patients had TGA-IVS.Three patients had abnormal coronary artery patterns,1 of whom had a single coronary artery and the left coronary artery was intramural.All 4 patients who died had bidirectional shunts at the level of the atrial septum,ventricular septum or ductus arteriosus.ConclutionIntact ventricular septum and lack of an effective blood shunt at the foramen ovale and ductus arteriosus are risk factors for early postpartum death.