Vol. 21 No. 2 (2017)
CONGENITAL HEART DISEASES

Two-stage anatomical repair of “simple” transposition of great arteries in neonates with extracardiac perinatal complications

PDF (Русский)
  • O. Kornoukhov,
  • V. Ilyin,
  • A. Valitova,
  • V. Kryukov
O. Kornoukhov
N.F. Filatov Pediatric City Clinical Hospital No. 13, 123001 Moscow, Russian Federation
Bio
V. Ilyin
N.F. Filatov Pediatric City Clinical Hospital No. 13, 123001 Moscow, Russian Federation
A. Valitova
N.F. Filatov Pediatric City Clinical Hospital No. 13, 123001 Moscow, Russian Federation
V. Kryukov
N.F. Filatov Pediatric City Clinical Hospital No. 13, 123001 Moscow, Russian Federation
DOI: https://doi.org/10.21688/1681-3472-2017-2-43-51

Published 2017-07-10

Keywords

  • ongenital heart disease,
  • cardiac surgery,
  • transposition of the great arteries,
  • arterial switch,
  • two-stage repair,
  • perinatal complications
    • ...More
    Less

How to Cite

Kornoukhov, O., Ilyin, V., Valitova, A., & Kryukov, V. (2017). Two-stage anatomical repair of “simple” transposition of great arteries in neonates with extracardiac perinatal complications. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 21(2), 43–51. https://doi.org/10.21688/1681-3472-2017-2-43-51

Copyright (c) 2017 Kornoukhov O.Yu., Ilyin V.N., Valitova A.A., Kryukov V.A.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Aim. This study was designed to analyse the results of two-stage arterial switch operation (ASO) of “simple” transposition of great arteries in patients with infection, neurological problems or necrotizing enterocolitis, which preclude neonatal surgery.
Methods. Transthoracic echocardiography data and outcomes of surgery were investigated in 19 patients (study group; #1) after two-stage ASO and 67 patients (control group; #2) after a single-stage ASO. Age of patients at the first stage was 27 (8–55) days and at the second stage 172 (92–256) days. Patients in group 2 were 7 (2–53) days old. All of them were followed up for 21 (4–49) months (group 1) and 40 (7–79) months (group 2) after arterial switch operation.
Results. There was no operative mortality at both stages in group 1. The duration of ventilation, length of intensive care unit and hospital stay after surgery were considerably lower in group 1. Actuarial sur-vival and freedom from reoperation at 4 years in group 1 accounted for 100%, while in the con-trol group those indicators at 6 years ran to 98.5% and 94%, respectively. The only difference detected by echocardiography was the aortic valve hinge points Z-score (3.9±1.44 vs 3.1±1.27; p=0.025) and sinuses of Valsalva (3.8±1.41 vs 2.8±1.19; p=0.03), which were higher in the 1st group. There was no aortic regurgitation >1 grade in both groups.
Conclusion. Two-stage repair of “simple” transposition of great arteries, when it’s necessary to delay arterial switch operation on the clinical grounds, can be performed with excellent clinical outcomes. The tendency of group 1 patients to have a larger neo-aortic root does not appear to bear any clinical significance in mid-term follow-up.

Received 21 December 2016. Accepted 8 May 2017.

Funding: The study had no sponsorship.
Conflict of interest: The authors declare no conflict of interest.
Author contributions
Study concept and design: Kornoukhov O.Yu., Ilyin V.N.
Data collection and analysis: Kornoukhov O.Yu., Valitova A.A., Kryukov V.A.
Drafting the article: Kornoukhov O.Yu.
Critical revision of the article: Kornoukhov O.Yu., Ilyin V.N.
Final approval of the version to be published: Kornoukhov: O.Yu., Ilyin V.N.

 

PDF (Русский)

References

  1. Yacoub M.H., Radley-Smith R., Maclaurin R. Two stage operation for anatomical correction of transposition of the great arteries with intact ventricular septum. Lancet. 1977;1(8025):1275-8.
  2. Yacoub M., Bernhard A., Lange P., Radley-Smith R., Keck E., Stephan E., Heintzen P. Clinical and hemodynamic results of the two-stage anatomic correction of simple TGA. Circulation. 1980;62(2 Pt 2):I190-6.
  3. Lacour-Gayet F., Piot D., Zoghi J., Serraf A., Gruber P., Mace L., Touchot A., Planche C. Surgical management and indication of left ventricular retraining in arterial switch of the great arteries with intact ventricular septum. Eur J Cardiothorac Surg. 2001;20(4):824-9.
  4. Jonas R.A., Giglia T.M., Sanders S.P., Wernowsky G., Nadal-Ginard B., Mayer J.E. Jr., Castaneda A.R. Rapid, two-stage arterial switch for transposition of the great arteries and intact ventricular septum beyond the neonatal period. Circulation. 1989;80(3 Pt 1):I203-8.
  5. Mavroudis C., Backer C. Pediatric Cardiac Surgery. Fourth Edition. Wiley-Blackwell; 2013. 458 p. http://dx.doi.org/10.1002/9781118320754
  6. Ross R.D. The Ross classification for heart failure in children after 25 years: a review and an age-stratified revision. Pediatr Cardiol. 2012;33(8):1295-300. http://dx.doi.org/10.1007/s00246-012-0306-8
  7. Prêtre R., Tamiser D., Bonhoeffer P., Mauriat P., Pouard P., Sidi D., Vouhe P. Results of the arterial switch operation in neonates with transposed great arteries. Lancet. 2001;357(9271):1826-30. http://dx.doi.org/10.1016/S0140-6736(00)04957-6
  8. Sidi D., Planche C., Kachaner J., Bruniaux J., Villain E., le Bidois J., Piechaud J.F., Lacour-Gayet F. Anatomic correction of simple transposition of the great arteries in 50 neonates. Circulation. 1987;75(2):429-35. https://doi.org/10.1161/01.CIR.75.2.429
  9. Foran J.P., Sullivan I.D., Elliott M.J., de Leval M.R. Primary arterial switch operation for transposition of the great arteries with intact ventricular septum in infants older than 21 days. J Am Coll Cardiol. 1998;31(4):883-9.
  10. Davis A.M., Wilkinson J.L., Karl T.R., Mee R.B. Transposition of the great arteries with intact ventricular septum. Arterial switch repair in patients 21 days of age or older. J Thorac Cardiovasc Surg. 1993;106(1):111-5.
  11. Kang N., de Leval M.R., Elliott M., Tsang V., Kocyildirim E., Sehic I., Foran J., Sullivan I. Extending the boundaries of the primary arterial switch operation in patients with transposition of the great arteries and intact ventricular septum. Circulation. 2004;110(11):II123-7. http://dx.doi.org/10.1161/01.CIR.0000138221.68312.33
  12. Nakazawa M., Oyama K., Imai Y., Nojima K., Aotsuka H., Satomi G., Kurosawa H., Takao A. Criteria for two staged arterial switch operation for simple transposition of great arteries. Circulation. 1988;78(1):124-31.
  13. Trusler G.A., Mustard W.T. A method of banding the pulmonary artery for large isolated ventricular septal defect with and without transposition of the great arteries. Ann Thorac Surg. 1972;13(4):351-5.
  14. Parker N.M., Zuhdi M., Kouatli A., Baslaim G. Late presenters with dextro-transposition of great arteries and intact ventricular septum: to train or not to train the left ventricle for arterial switch operation? Congenit Heart Dis. 2009;4(6):424-32. http://dx.doi.org/10.1111/j.1747-0803.2009.00352.x
  15. Dabritz S., Engelhardt W., von Bernuth G., Mesner B.J. Trial of pulmonary artery banding: a diagnostic criterion for ‘one stage’ arterial switch in simple transposition of the great arteries beyond the neonatal period. Eur J Cardiothorac Surg. 1997;11(1):112-6.
  16. Jonas R.A. Comprehensive surgical management of congenital heart disease. Second Edition. CRC press; 2014. 391 p.
  17. Wernovsky G., Hougen T.J., Walsh E.P., Sholler G.F., Colan S.D., Sanders S.P., Parness I.A., Keane J.F., Mayer J.E., Jonas R.A. Midterm results after arterial switch operation for transposition of the great arteries with intact ventricular septum: clinical, hemodynamic, echocardiographic, and electrophysiologic data. Circulation. 1988;77(6):1333-44.
  18. Sсhroeder J., Albert J., Clarke D., Schaffer M., Wolfe R., Hays T. Hemolysis due branch pulmonary stenosis after the arterial switch procedure. Ann Thorac Surg. 1991;51(3):491-2. https://doi.org/10.1016/0003-4975(91)90878-T
  19. Jenkins K.J., Hanley F.L., Colan C.D., Mayer J.E., Castaneda A.R., Wernovsky G. Function of the anatomic pulmonary valve in the systemic circulation. Circulation. 1991;84(5 Suppl):III173-9.
  20. Schwartz M.L., Gauvreau K., del Nido P., Mayer J.E., Colan S.D. Long-term predictors of aortic root dilation and aortic regurgitation after arterial switch operation. Circulation. 2004;110:II-128-II-132. https://doi.org/10.1161/01.CIR.0000138392.68841.d3
  21. Losay J., Touchot A., Capderou A., Piot J.D., Belli E., Planche C., Serraf A. Aortic valve regurgitation after arterial switch operation for transposition of the great arteries: incidence, risk factors, and outcome. J Am Coll Cardiol. 2006;47(10):2057-62. https://doi.org/10.1016/j.jacc.2005.12.061
  22. Lo Rito M., Fittipaldi M., Haththotuwa R., Jones T.J., Khan N., Clift P., Brawn W.J., Barron D.J. Long-term fate of the aortic valve after an arterial switch operation. J Thorac Cardiovasc Surg. 2015;149(4):1089-94. https://doi.org/10.1016/j.jtcvs.2014.11.075
  23. Hazekamp M.G. Long-term follow-up after the arterial switch operation: Not as perfect as we would have hoped? J Thorac Cardiovasc Surg. 2015;149(4):968. https://doi.org/10.1016/j.jtcvs.2014.12.026