Clinical characteristics and risk factors for prolonged recovery after one-stage arterial switch operation for patients with transposition of the great arteries_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LU Zhongyuan ¹ ,  WANG Xu ¹ , LI Shoujun ² , YAN Jun ² , ZENG Min ¹ , LI Shengli ¹ , LI Xia ¹

1. Pediatric ICU, Pediatric Cardiac Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100037, P.R.China;
2. Department of Surgery, Pediatric Cardiac Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding author：

WANG Xu, Email: fwpicu@163.com

Keywords：

Transposition of the great arteries; arterial switch operation; prolonged recovery; risk factors

DOI：

10.7507/1007-4848.202003043

Video：

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Objective To summarize the early clinical features and perioperative management strategies for patients with transposition of the great arteries (TGA) after one-stage arterial switch operation (ASO), and investigate the risk factors for prolonged recovery in ICU, with a focus on the age structure and deformity complexity.Methods The clinical data of 231 consecutive TGA patients who underwent one-stage ASO were retrospectively analyzed. There were 165 males and 66 females, aged from 3 d to 10 years. The patients were sequenced by the length of ICU stay. The time at the 75^th percentile was defined as the critical value for grouping. Patients with an ICU stay time over this point were allocated to a prolonged recovery group (n=54), while the rest were allocated to a normal recovery group (n=177). The perioperative clinical data were compared between the two groups, and the risk factors for prolonged recovery were evaluated.Results About half (49.6%) of the patients received late operation. The mean ICU stay time was 23.9±15.6 d in the prolonged recovery group, and 4.9±2.3 d in the normal recovery group. Complication of aortic arch lesion, delayed chest closure and postoperative pulmonary infection were independent risk factors for prolonged recovery after ASO in ICU. However, late operation had no significant effect on the overall recovery.Conclusion With strict surgery indications and excellent postoperative management, most patients can have satisfactory early-stage outcomes, but are confronted with increased complications, which is associated with prolonged recovery. Complication of aortic arch lesion, delayed chest closure and postoperative pulmonary infection are independent factors for delayed recovery of ASO.

Citation： LU Zhongyuan, WANG Xu, LI Shoujun, YAN Jun, ZENG Min, LI Shengli, LI Xia. Clinical characteristics and risk factors for prolonged recovery after one-stage arterial switch operation for patients with transposition of the great arteries. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(1): 43-47. doi: 10.7507/1007-4848.202003043 Copy

1.	Sarris GE, Balmer C, Bonou P, 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(1): e1-e32.1-32.
2.	董念国, 李守军. 先天性心脏病外科治疗中国专家共识 (一): 大动脉调转术应用. 中国胸心血管外科临床杂志, 2020, 27(2): 126-132.
3.	Schidlow DN, Jenkins KJ, Gauvreau K, et al. Transposition of the great arteries in the developing world: Surgery and outcomes. J Am Coll Cardiol, 2017, 69(1): 43-51.
4.	Villafañe J, Lantin-Hermoso MR, Bhatt AB, et al. D-transposition of the great arteries: The current era of the arterial switch operation. J Am Coll Cardiol, 2014, 64(5): 498-511.
5.	Sasaki J, Dykes JC, Sosa LJ, et al. Risk factors for longer hospital stay following the Fontan operation. Pediatr Crit Care Med, 2016, 17(5): 411-419.
6.	Jacobs JP, Jacobs ML, Mavroudis C, et al. Transposition of the great arteries: Lessons learned about patterns of practice and outcomes from the Congenital Heart Surgery Database of the Society of Thoracic Surgeons. World J Pediatr Congenit Heart Surg, 2011, 2(1): 19-31.
7.	Turon-Viñas A, Riverola-de Veciana A, Moreno-Hernando J, et al. Characteristics and outcomes of transposition of great arteries in the neonatal period. Rev Esp Cardiol (Engl Ed), 2014, 67(2): 114-119.
8.	Cain MT, Cao Y, Ghanayem NS, et al. Transposition of the great arteries--outcomes and time interval of early neonatal repair. World J Pediatr Congenit Heart Surg, 2014, 5(2): 241-247.
9.	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(5): 481-487.
10.	Ahlström L, Odermarsky M, Malm T, et al. Surgical age and morbidity after arterial switch for transposition of the great arteries. Ann Thorac Surg, 2019, 108(4): 1242-1247.
11.	Fricke TA, Bulstra AE, Loyer BR, et al. Outcomes of the arterial switch operation in children less than 2.5 kilograms. Ann Thorac Surg, 2017, 103(3): 840-844.
12.	Salna M, Chai PJ, Kalfa D, et al. Outcomes of the arterial switch operation in ≤2.5-kg neonates. Semin Thorac Cardiovasc Surg, 2019, 31(3): 488-493.
13.	Gupta N, Leven L, Stewart M, et al. Transport of infants with congenital heart disease: Benefits of antenatal diagnosis. Eur J Pediatr, 2014, 173(5): 655-660.
14.	Zijlstra WM, Elmasry O, Pepplinkhuizen S, et al. Pulmonary arterial hypertension in children after neonatal arterial switch operation. Heart, 2017, 103(16): 1244-1249.
15.	Stoica S, Carpenter E, Campbell D, et al. Morbidity of the arterial switch operation. Ann Thorac Surg, 2012, 93(6): 1977-1983.
16.	Ota N, Sivalingam S, Pau KK, et al. Primary arterial switch operation for late referral of transposition of the great arteries with intact ventricular septum in the current era: Do we still need a rapid two-stage operation? World J Pediatr Congenit Heart Surg, 2018, 9(1): 74-78.
17.	Erek E, Yalcinbas YK, Turkekul Y, et al. Indications and risks of delayed sternal closure after open heart surgery in neonates and early infants. World J Pediatr Congenit Heart Surg, 2012, 3(2): 229-235.

1. Sarris GE, Balmer C, Bonou P, 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(1): e1-e32.1-32.
2. 董念国, 李守军. 先天性心脏病外科治疗中国专家共识 (一): 大动脉调转术应用. 中国胸心血管外科临床杂志, 2020, 27(2): 126-132.
3. Schidlow DN, Jenkins KJ, Gauvreau K, et al. Transposition of the great arteries in the developing world: Surgery and outcomes. J Am Coll Cardiol, 2017, 69(1): 43-51.
4. Villafañe J, Lantin-Hermoso MR, Bhatt AB, et al. D-transposition of the great arteries: The current era of the arterial switch operation. J Am Coll Cardiol, 2014, 64(5): 498-511.
5. Sasaki J, Dykes JC, Sosa LJ, et al. Risk factors for longer hospital stay following the Fontan operation. Pediatr Crit Care Med, 2016, 17(5): 411-419.
6. Jacobs JP, Jacobs ML, Mavroudis C, et al. Transposition of the great arteries: Lessons learned about patterns of practice and outcomes from the Congenital Heart Surgery Database of the Society of Thoracic Surgeons. World J Pediatr Congenit Heart Surg, 2011, 2(1): 19-31.
7. Turon-Viñas A, Riverola-de Veciana A, Moreno-Hernando J, et al. Characteristics and outcomes of transposition of great arteries in the neonatal period. Rev Esp Cardiol (Engl Ed), 2014, 67(2): 114-119.
8. Cain MT, Cao Y, Ghanayem NS, et al. Transposition of the great arteries--outcomes and time interval of early neonatal repair. World J Pediatr Congenit Heart Surg, 2014, 5(2): 241-247.
9. 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(5): 481-487.
10. Ahlström L, Odermarsky M, Malm T, et al. Surgical age and morbidity after arterial switch for transposition of the great arteries. Ann Thorac Surg, 2019, 108(4): 1242-1247.
11. Fricke TA, Bulstra AE, Loyer BR, et al. Outcomes of the arterial switch operation in children less than 2.5 kilograms. Ann Thorac Surg, 2017, 103(3): 840-844.
12. Salna M, Chai PJ, Kalfa D, et al. Outcomes of the arterial switch operation in ≤2.5-kg neonates. Semin Thorac Cardiovasc Surg, 2019, 31(3): 488-493.
13. Gupta N, Leven L, Stewart M, et al. Transport of infants with congenital heart disease: Benefits of antenatal diagnosis. Eur J Pediatr, 2014, 173(5): 655-660.
14. Zijlstra WM, Elmasry O, Pepplinkhuizen S, et al. Pulmonary arterial hypertension in children after neonatal arterial switch operation. Heart, 2017, 103(16): 1244-1249.
15. Stoica S, Carpenter E, Campbell D, et al. Morbidity of the arterial switch operation. Ann Thorac Surg, 2012, 93(6): 1977-1983.
16. Ota N, Sivalingam S, Pau KK, et al. Primary arterial switch operation for late referral of transposition of the great arteries with intact ventricular septum in the current era: Do we still need a rapid two-stage operation? World J Pediatr Congenit Heart Surg, 2018, 9(1): 74-78.
17. Erek E, Yalcinbas YK, Turkekul Y, et al. Indications and risks of delayed sternal closure after open heart surgery in neonates and early infants. World J Pediatr Congenit Heart Surg, 2012, 3(2): 229-235.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical characteristics and risk factors for prolonged recovery after one-stage arterial switch operation for patients with transposition of the great arteries

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