LB7. Outcomes of the "Univentricular Arterial Switch Operation" in Patients with Single Ventricle Morphology & Transposition of the Great Arteries
KOKILABEN DHIRUBHAI AMBANI HOSPITAL
Mumbai, Maharashtra
India - Contact Me
Dr. Smruti Ranjan Mohanty is a Senior Consultant Congenital Heart Surgeon who practises at the Kokilaben Dhirubhai Ambani Hospital & Medical Research Institute in Mumbai. He is a senior member of a comprehensive cardiac care team with over a quarter-century of expertise and experience accumulated from dedicated training in congenital heart surgery. He was educated at the All India Institute of Medical Sciences, New Delhi and was the 2004-05 Evarts A. Graham Fellow of the American Association for Thoracic Surgery.
Maintains an active, full-time practise in congenital heart surgery as a senior attending and faculty at a stand-alone paediatric cardiac program in the nation’s financial capital, which serves the entire landscape of Western India. Involved in establishing the congenital heart program at KDAH, which is an elite program that establishes the benchmark in outcomes for complex neonatal and congenital heart surgery across the Indian subcontinent and South Asia. He is involved in caring for the entire spectrum of CHD, from neonates to adults with GUCH in the unit that performs over 750 open-heart cases annually. Routine workload involves intracardiac repairs for simple CHDs, and a large chunk of work with TGA, Arch Hypoplasia, functionally univentricular heart repairs and an active mechanical circulatory support program.
Surgical lead for the HLHS, PAH and paediatric transplant programs, in addition to scientific and academia related matters.
Involved in training Fellows and Medical Students in pursuing a career in academic congenital heart surgery and developing research projects in the department to distil the by-products of research work in routine clinical practise and patient care.
Description
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.
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