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Arterial switch operation in patients with transposition and a left-sided aorta

Published online by Cambridge University Press:  11 July 2017

Sachin Talwar ,
Robert H. Anderson ,
Pradeep Ramakrishnan ,
Amolkumar Bhoje ,
Saurabh Gupta ,
Shiv Kumar Choudhary  and
Balram Airan
Sachin Talwar*
Affiliation:
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Robert H. Anderson
Affiliation:
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India Newcastle University of Genetic Medicine, Newcastle-upon-Tyne, United Kingdom
Pradeep Ramakrishnan
Affiliation:
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Amolkumar Bhoje
Affiliation:
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Saurabh Gupta
Affiliation:
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Shiv Kumar Choudhary
Affiliation:
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
Balram Airan
Affiliation:
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
*
Correspondence to: Professor S. Talwar, Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi 110029, India. Tel: +91 112 659 4835; Fax: +91 112 658 8663; E-mail: sachintalwar@hotmail.com
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Abstract

Objectives

Arterial switch operation is the treatment of choice in infants with transposed arterial trunks. It is technically challenging to perform in patients having usual atrial arrangement and concordant atrioventricular connections but having a left-sided aorta. Correction in this setting requires surgical expertise and precision. Here we review our experience with such patients.

Methods

Between January, 2002 and October, 2013, the arterial switch operation was performed in 20 patients in the combination emphasised above. Patient records were analysed in detail for coronary arterial patterns, and for the techniques used for transfer of the coronary arteries and reconstruction of the great arteries. Outcomes were recorded in terms of in-hospital survival and left ventricular function at the most recent follow-up.

Results

All patients survived the procedure. Ages ranged from 3 days to 18 months, with a median of 75 days; the weight of the patients ranged from 3 to 8.8 kg, with a median of 3.85 kg. The LeCompte manoeuvre was performed in only nine patients. The mean cardiopulmonary bypass time was 157.5±24.9, with a median of 161 minutes, and the mean aortic cross-clamp time was 101.2±23.8, with a median of 102 minutes. Subsequently, two patients died: the first due to a sudden onset of ventricular fibrillation and the second during a crisis of severe pulmonary hypertension. At the last follow-up, which ranged from 23 to 41 months, with a mean of 38.04±2.32 and a median of 38.4 months, all 18 survivors were in NYHA class I, with none requiring cardiac medications and all having normal bi-ventricular function without residual defects.

Conclusion

With appropriate technical modifications, patients with concordant atrioventricular and discordant ventriculo-arterial connections with a left-sided aorta can undergo successful anatomical repair.

Keywords

Discordant ventriculo-arterial connectionsarterial switch operationanatomical repair
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 9 , November 2017 , pp. 1771 - 1777
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Copyright
© Cambridge University Press 2017 

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Footnotes

Abstract accepted for presentation at the 7th World Congress of Pediatric Cardiology and Cardiac Surgery (WCPCCS), Barcelona, Spain, 16–21 July, 2017.

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