Outcomes of the “Univentricular Arterial Switch Operation” in Patients with Single Ventricle Morphology & Transposition of the Great Arteries
Presented During:
Sunday, April 28, 2024: 9:30AM - 9:37AM
Metro Toronto Convention Center
Posted Room Name:
Room 716
Abstract No:
LB007
Submission Type:
Late Breaking Prospective Clinical Trial Abstract Submission
Authors:
Smruti Ranjan Mohanty (1), Aditya Doddamane (1), Bipin Radhakrishnan (1), Prashant Bobhate (1), Tanuja Karande (1), Kamlesh Tailor (1), Shankar Kadam (1), Keyoor Bhavsar (1), Nilesh Bohra (1), Suresh Gururaja Rao (1)
Institutions:
(1) Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute, Mumbai, India
Submitting Author:
Smruti Ranjan Mohanty
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Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute
Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute
Co-Author(s):
Aditya Doddamane
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Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute
Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute
Bipin Radhakrishnan
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Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute
Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute
Prashant Bobhate
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Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute
Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute
Tanuja Karande
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Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute
Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute
Kamlesh Tailor
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Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute
Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute
Shankar Kadam
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Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute
Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute
Keyoor Bhavsar
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Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute
Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute
Nilesh Bohra
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Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute
Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute
Suresh Gururaja Rao
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Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute
Children's Heart Center, Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute
Presenting Author:
Smruti Ranjan Mohanty
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Abstract:
OBJECTIVE
To evaluate the intermediate survival in patients with univentricular hearts, transposition of great arteries & arch hypoplasia who underwent the univentricular arterial switch operation (uASO), in lieu of the conventional pulmonary artery band palliation.
METHODS
Patients with functionally univentricular hearts or single ventricle morphology undergoing uASO were shortlisted from the institutional congenital heart surgery database.
RESULTS
Seventeen patients underwent the uASO at a median age of 46 days (IQR: 30-49 days). There were 10 male children (59%). Primary diagnoses included Double Inlet LV in 13 patients (76%), hypoplastic right ventricular apparatus in 3 patients (18%) and straddling tricuspid valve in 1 patient (6%).
Concomitant procedures at the initial operation included aortic arch reconstruction under antegrade perfusion in 10 patients (59%), atrial septectomy in 8 patients (47%), tricuspid valve repair & exclusion in 1 patient (6%), each.
As part of the ASO, pulmonary blood flow was regulated either with pulmonary artery banding in 4 patients (24%), or graft interposition in 13 patients. The LeCompte manoeuvre in the initial part of our experience was avoided thereafter to retain the normal alignment of the pulmonary arteries. The median size of the interposition graft was 6 mm.
Median durations of CPB & aortic cross clamp were 240 & 146 minutes, respectively. There was 1 immediate operative death (6%), and 2 early deaths in this series. Median intensive care & hospital stays were 17 and 26 days, respectively. Six of the 14 survivors (43%) have advanced to Stage-2 palliation, while the other 8 are awaiting it.
Survival remained steady at 82% in the overall cohort, with the interstage period witnessing no attrition in survival or reinterventions. All 14 survivors were alive at last follow-up (median, 20 months) with mild neoaortic insufficiency, no residual systemic outflow tract obstruction, normal arch configuration, good left ventricular function & adequate pulmonary blood flow.
CONCLUSION
In a single sitting, the uASO addresses the hypoplastic arch, offers anatomical stabilisation of the ventriculoarterial junction & regulates pulmonary over-circulation. On the edifice of these principles, the outcomes from our experience demonstrate the physiological superiority & safety of this operation as a novel strategy for the morphology of univentricular hearts with transposition & arch hypoplasia.
To evaluate the intermediate survival in patients with univentricular hearts, transposition of great arteries & arch hypoplasia who underwent the univentricular arterial switch operation (uASO), in lieu of the conventional pulmonary artery band palliation.
METHODS
Patients with functionally univentricular hearts or single ventricle morphology undergoing uASO were shortlisted from the institutional congenital heart surgery database.
RESULTS
Seventeen patients underwent the uASO at a median age of 46 days (IQR: 30-49 days). There were 10 male children (59%). Primary diagnoses included Double Inlet LV in 13 patients (76%), hypoplastic right ventricular apparatus in 3 patients (18%) and straddling tricuspid valve in 1 patient (6%).
Concomitant procedures at the initial operation included aortic arch reconstruction under antegrade perfusion in 10 patients (59%), atrial septectomy in 8 patients (47%), tricuspid valve repair & exclusion in 1 patient (6%), each.
As part of the ASO, pulmonary blood flow was regulated either with pulmonary artery banding in 4 patients (24%), or graft interposition in 13 patients. The LeCompte manoeuvre in the initial part of our experience was avoided thereafter to retain the normal alignment of the pulmonary arteries. The median size of the interposition graft was 6 mm.
Median durations of CPB & aortic cross clamp were 240 & 146 minutes, respectively. There was 1 immediate operative death (6%), and 2 early deaths in this series. Median intensive care & hospital stays were 17 and 26 days, respectively. Six of the 14 survivors (43%) have advanced to Stage-2 palliation, while the other 8 are awaiting it.
Survival remained steady at 82% in the overall cohort, with the interstage period witnessing no attrition in survival or reinterventions. All 14 survivors were alive at last follow-up (median, 20 months) with mild neoaortic insufficiency, no residual systemic outflow tract obstruction, normal arch configuration, good left ventricular function & adequate pulmonary blood flow.
CONCLUSION
In a single sitting, the uASO addresses the hypoplastic arch, offers anatomical stabilisation of the ventriculoarterial junction & regulates pulmonary over-circulation. On the edifice of these principles, the outcomes from our experience demonstrate the physiological superiority & safety of this operation as a novel strategy for the morphology of univentricular hearts with transposition & arch hypoplasia.
Category:
Congenital
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