Mortality analysis of arterial switch operation for transposition of the great arteries with and without ventricular septal defect

Soichiro Kitamura, Hisateru Tachimori, Arata Murakami, Hiroaki Kawata, Hajime Ichikawa, Hiroaki Miyata

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVES: We aimed to evaluate the 90-day mortality and effect of rescue or urgent coronary revascularization in children undergoing arterial switch operation for transposition of the great arteries with and without ventricular septal defect. METHODS: The 90-day mortality, risk factors for mortality and outcome of rescue or urgent coronary revascularization were analysed using 8 years of data from the Japan Cardiovascular Surgical Database. We only included patients with full data for all analyses. RESULTS: A total of 1084 patients (median weight: 3.0 kg; interquartile range: 2.8-3.3) underwent arterial switch operation at a median age of 10 days (interquartile range: 7-14). The 90-day mortality (5.2%, n = 56) was ∼1.6-fold higher than 30-day mortality (3.2%, n = 35). The cause was cardiac origin in 84% of non-survivors. Fifty-nine of the 1034 patients (5.7%) required extracorporeal membrane oxygenation (ECMO), with successful weaning in 44% (n = 26). Univariable or multivariable analyses revealed the following risk factors for mortality: body weight at operation <2.5 kg, aortic cross-clamp time, cardiac events and ECMO (P < 0.005-0.001). Ventricular septal defect was not a risk factor. Thirteen patients (1.2%) had either rescue or urgent coronary revascularization with salvage rates of 25% (2/8) and 100% (5/5), respectively. Only 5 ECMO patients (8%) underwent coronary revascularization with 1 survivor. CONCLUSIONS: The 90-day mortality represented perioperative outcomes better than 30-day mortality. Patients on ECMO, which extended the survival time, had 56% 90-day mortality. Coronary revascularization showed a salvaging effect, although the case number was small.

Original languageEnglish
Pages (from-to)797-804
Number of pages8
JournalEuropean Journal of Cardio-thoracic Surgery
Volume61
Issue number4
DOIs
Publication statusPublished - 2022 Apr 1

Keywords

  • Arterial switch operation
  • Coronary Revascularization
  • Extracorporeal membrane oxygenation
  • Mortality
  • Rescue operation
  • Transposition of the great arteries

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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