138. Early versus Late Arterial Switch Operation for d-Transposition of Great Arteries with Ventricular Septal Defect without Outflow Tract Obstruction
Presented During: Congenital Rapid Fire Orals
Department of Cardiothoracic Surgery, Cincinnati Children’s Hospital Medical Center
Cincinnati, OH
United States - Contact Me
I am a Heart Institute researcher at Cincinnati Children’s Hospital Medical Center under Dr. David L. S. Morales. My work spans between clinical, translational, and basic science research. My research is primarily focused within the field of congenital heart disease and its surgical palliations, investigating outcomes for mechanical circulatory support, semilunar valve replacement, and heart transplantation.
Sunday, April 28, 2024: 10:26 AM - 10:33 AM
7 Minutes
Metro Toronto Convention Center
Room: Room 716
Description
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.
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
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.
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
Presentation Duration
You will have a 4 minute presentation followed by 3 minutes of discussion from the audience. All presenters must adhere to the presentation and discussion times provided. The AATS will begin to play music once your speaking time is exceeded.