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Author Affiliations: Surgical ICU, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China (Zhu LX, Tan LH, He XJ, Zhang CY, Yu YP, Zhang ZW)
Corresponding Author: Lin-Hua Tan, MD, Surgical ICU, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China (Tel: 86-571-87061007; Fax: 86-571-87033296; Email: linhua_tan@yahoo.com)
Background: Arterial switch operation (ASO) has been optimal for children with transposition of great arteries (TGA) in either simple or complex form with an excellent survival rate. This operation was introduced late in China, but there has been a decreasing mortality in recent years. Optimizing the postoperative management has been essential to improve the survival rate after ASO. This study summarizes the experience in the management of the postoperative complications after ASO.
Methods: Twenty-eight infants with TGA underwent ASO from January 2004 through December 2006. These patients aged 1-70 days (median, 6 days) had a body weight of 3.36¡À0.57 kg on average. Before operation, continuous intravenous infusion of prostaglanding E1 was routinely used to keep the ductus open with a SpO2 of 75%-90%. Ten patients required tracheal intubation and mechanical ventilation. Two patients underwent emergency ASO under general anesthesia and low-flow cardiopulmonary bypass or hypothermic circulatory arrest. All the 28 patients were further treated with modified ultrafiltration and delayed sternal closure after cessation of cardiopulmonary bypass. After ASO, they were on circulatory and respiratory support, with antibiotics, nutritional supplement in the ICU.
Results: The patients had a cardiopulmonary bypass time of 167¡À32 minutes and an aortic cross-clamping time of 101¡À24 minutes. Delayed sternal closure was carried out on 3.63¡À1.49 days after ASO. They had a mechanical ventilation of 5.89¡À3.02 days and an ICU stay of 10.12¡À3.25 days. There were 5 deaths after ASO with a mortality rate of 17.9%. Fifteen patients developed low cardiac output syndrome. In 12 patients presenting with cardiac arrhythmias, 9 had paroxysmal supraventricular tachycardia, 1 had frequent ventricular premature beats, 1 had ventricular tachycardia, and 1 had ventricular fibrillation. One patient suffered from pulmonary hypertensive crisis. Three patients with major bleeding and tamponade required emergency mediastinal exploration and finally survived. There were 6 patients with ventilator-associated pneumonia, 6 with delayed incision healing, and 1 with chylothorax.
Conclusions: The complications after ASO are common and complicated. Understanding of the physiological characteristics of infants and the pathophysiological changes, and optimizing postoperative treatment help to improve the survival rate after ASO.
Key words: transposition of great arteries; arterial switch operation; complication; infant World J Pediatr 2007;3(4):300-304
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