Early versus Late Arterial Switch Operation for d-Transposition of Great Arteries with Ventricular Septal Defect without Outflow Tract Obstruction
Presented During:
Sunday, April 28, 2024: 10:26AM - 10:33AM
Metro Toronto Convention Center
Posted Room Name:
Room 716
Abstract No:
138
Submission Type:
Abstract Submission
Authors:
Muhammad Faateh (1), Spencer Hogue (2), Amir Mehdizadeh-Shrifi (1), Kevin Kulshrestha (1), David Lehenbauer (1), David Morales, Sr. (1), Awais Ashfaq (1)
Institutions:
(1) The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (2) Department of Cardiothoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
Submitting Author:
Muhammad Faateh
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The Heart Institute, Cincinnati Children's Hospital Medical Center
The Heart Institute, Cincinnati Children's Hospital Medical Center
Co-Author(s):
Spencer Hogue
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Department of Cardiothoracic Surgery, Cincinnati Children’s Hospital Medical Center
Department of Cardiothoracic Surgery, Cincinnati Children’s Hospital Medical Center
Amir Mehdizadeh-Shrifi
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The Heart Institute, Cincinnati Children's Hospital Medical Center
The Heart Institute, Cincinnati Children's Hospital Medical Center
Kevin Kulshrestha
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The Heart Institute, Cincinnati Children's Hospital Medical Center
The Heart Institute, Cincinnati Children's Hospital Medical Center
David Lehenbauer
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The Heart Institute, Cincinnati Children's Hospital Medical Center
The Heart Institute, Cincinnati Children's Hospital Medical Center
*David Morales, Sr.
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The Heart Institute, Cincinnati Children's Hospital Medical Center
The Heart Institute, Cincinnati Children's Hospital Medical Center
Awais Ashfaq
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The Heart Institute, Cincinnati Children's Hospital Medical Center
The Heart Institute, Cincinnati Children's Hospital Medical Center
Presenting Author:
Muhammad Faateh
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Abstract:
Introduction: The ideal timing for Arterial Switch Operation (ASO) in patients with d-Transposition of Great Arteries (d-TGA) and Ventricular Septal Defect (VSD) without outflow tract obstruction remains inconclusive. We assessed the impact of timing of surgical correction on outcomes.
Methods: Neonates with d-TGA + VSD who underwent ASO + VSD repair at age ≤ 30 days were identified from the Pediatric Health Information System database from 2004-2022. Patients with outflow tract obstruction were excluded. Patients were categorized into four groups based on age (in days) when ASO was performed: Group 1 (0-7 days), Group 2 (8-14 days), Group 3 (15-21 days), and Group 4 (>21 days). Baseline demographics, presence of Patent Ductus Arteriosus (PDA), Balloon Atrial Septostomy (BAS) were compared. Outcomes including mortality, length of stay, post-op ECMO use were analyzed by timing of ASO.
Results: A total of 1,005 patients were identified of which 652(64.9%) underwent ASO in group 1, 247(24.6%) in group 2, 72(7.2%) in group 3 and 34(3.4%) in group 4. Overall, groups were similar in terms of gender, prematurity, pre-op ECMO use, and presence of coronary anomalies (all P>0.05). Patients in groups 3 and 4 were more likely to be of lower birth weight. Unadjusted outcomes including in-hospital mortality, post-op ECMO, delayed sternum closure, non-home discharge, and post-op length of stay were similar between the groups. The multivariate odds of composite outcome of death/post-op ECMO/delayed sternum closure/non-home discharge were higher, comparing patients in group 1(0-7 days) vs group 2-4(>7 days) (aOR 1.54, 95% CI: 1.09-2.19, p=0.016). (Table)
Conclusion: Our analysis of >1,000 neonates with d-Transposition of Great Arteries + ventricular septal defect without outflow tract obstruction reveals that outcomes of Arterial Switch Operation + VSD repair are better if performed within the first week of life.
Methods: Neonates with d-TGA + VSD who underwent ASO + VSD repair at age ≤ 30 days were identified from the Pediatric Health Information System database from 2004-2022. Patients with outflow tract obstruction were excluded. Patients were categorized into four groups based on age (in days) when ASO was performed: Group 1 (0-7 days), Group 2 (8-14 days), Group 3 (15-21 days), and Group 4 (>21 days). Baseline demographics, presence of Patent Ductus Arteriosus (PDA), Balloon Atrial Septostomy (BAS) were compared. Outcomes including mortality, length of stay, post-op ECMO use were analyzed by timing of ASO.
Results: A total of 1,005 patients were identified of which 652(64.9%) underwent ASO in group 1, 247(24.6%) in group 2, 72(7.2%) in group 3 and 34(3.4%) in group 4. Overall, groups were similar in terms of gender, prematurity, pre-op ECMO use, and presence of coronary anomalies (all P>0.05). Patients in groups 3 and 4 were more likely to be of lower birth weight. Unadjusted outcomes including in-hospital mortality, post-op ECMO, delayed sternum closure, non-home discharge, and post-op length of stay were similar between the groups. The multivariate odds of composite outcome of death/post-op ECMO/delayed sternum closure/non-home discharge were higher, comparing patients in group 1(0-7 days) vs group 2-4(>7 days) (aOR 1.54, 95% CI: 1.09-2.19, p=0.016). (Table)
Conclusion: Our analysis of >1,000 neonates with d-Transposition of Great Arteries + ventricular septal defect without outflow tract obstruction reveals that outcomes of Arterial Switch Operation + VSD repair are better if performed within the first week of life.
CONGENTIAL:
Neonatal and Pediatric Cardiac Surgery
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