Kai Ma1, Zhongdong Hua1, Keming Yang1, Shengshou Hu1, Francois Lacour-Gayet2, Jun Yan1, Hao Zhang1, Xiangbin Pan1, Qiuming Chen1, Shoujun Li3. 1. Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China. 2. Department of Cardiothoracic Surgery, Children's Hospital at Montefiore, Bronx, New York. 3. Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China. Electronic address: drlishoujun@yahoo.com.
Abstract
BACKGROUND: Late referral of patients with transposition of the great arteries (TGA) and intact ventricular septum (IVS) is common in China. This study investigates the impact of later age on the arterial switch operation (ASO) performed for TGA-IVS beyond 1 month of age. METHODS: From 2000 to 2011, a total 109 patients with TGA-IVS were referred over 1 month of age. In group A, 78 patients with satisfactory left ventricular (LV) geometry underwent a one-stage ASO. In group B, 31 patients with LV regression underwent a two-stage ASO with prior LV retraining. RESULTS: The median age at ASO was older in group B (6 months, versus group A 1.9 months; p = 0.01). Group A had more frequent patent ductus arteriosus (70.5%, versus group B 38.7%; p = 0.02). The in-hospital mortality was similar in both groups (group A 2.6%, group B 9.7%; p = 0.14). Late mortality was higher in group B (16%, versus group A 2.7%; p = 0.03), as well as aortic regurgitation rate (group A 9.8% versus group B 33.3%; p = 0.01). The median duration of retraining in group B was 18 days. There were no deaths at retraining, although 2 patients required revision of the pulmonary artery banding. The only significant risk factor for late mortality in group B was age at retraining, as continuous variable (p = 0.04). Age beyond 3 months at LV retraining was associated with late impaired LV ejection fraction (p = 0.01). CONCLUSIONS: The overall outcomes of ASO for TGA-IVS performed beyond 1 month of age are satisfactory. Two-stage ASO has higher late mortality and more neoaortic regurgitation. Later age at retraining is associated with higher late mortality. Age beyond 3 months at retraining is associated with impaired LV function.
BACKGROUND: Late referral of patients with transposition of the great arteries (TGA) and intact ventricular septum (IVS) is common in China. This study investigates the impact of later age on the arterial switch operation (ASO) performed for TGA-IVS beyond 1 month of age. METHODS: From 2000 to 2011, a total 109 patients with TGA-IVS were referred over 1 month of age. In group A, 78 patients with satisfactory left ventricular (LV) geometry underwent a one-stage ASO. In group B, 31 patients with LV regression underwent a two-stage ASO with prior LV retraining. RESULTS: The median age at ASO was older in group B (6 months, versus group A 1.9 months; p = 0.01). Group A had more frequent patent ductus arteriosus (70.5%, versus group B 38.7%; p = 0.02). The in-hospital mortality was similar in both groups (group A 2.6%, group B 9.7%; p = 0.14). Late mortality was higher in group B (16%, versus group A 2.7%; p = 0.03), as well as aortic regurgitation rate (group A 9.8% versus group B 33.3%; p = 0.01). The median duration of retraining in group B was 18 days. There were no deaths at retraining, although 2 patients required revision of the pulmonary artery banding. The only significant risk factor for late mortality in group B was age at retraining, as continuous variable (p = 0.04). Age beyond 3 months at LV retraining was associated with late impaired LV ejection fraction (p = 0.01). CONCLUSIONS: The overall outcomes of ASO for TGA-IVS performed beyond 1 month of age are satisfactory. Two-stage ASO has higher late mortality and more neoaortic regurgitation. Later age at retraining is associated with higher late mortality. Age beyond 3 months at retraining is associated with impaired LV function.
Authors: David N Schidlow; Kathy J Jenkins; Kimberlee Gauvreau; Ulisses A Croti; Do Thi Cam Giang; Rama K Konda; William M Novick; Nestor F Sandoval; Aldo Castañeda Journal: J Am Coll Cardiol Date: 2017-01-03 Impact factor: 24.094
Authors: Adrienne N Wilburn; George D Giraud; Samantha Louey; Terry Morgan; Nainesh Gandhi; Sonnet S Jonker Journal: Am J Physiol Regul Integr Comp Physiol Date: 2018-09-12 Impact factor: 3.619
Authors: Juan Villafañe; M Regina Lantin-Hermoso; Ami B Bhatt; James S Tweddell; Tal Geva; Meena Nathan; Martin J Elliott; Victoria L Vetter; Stephen M Paridon; Lazaros Kochilas; Kathy J Jenkins; Robert H Beekman; Gil Wernovsky; Jeffrey A Towbin Journal: J Am Coll Cardiol Date: 2014-08-05 Impact factor: 24.094