1
|
Seese L, Castrillon CD, Da Silva LDF, Tarun S, Castro-Medina M, Viegas M, Da Silva JP, Morell VO. Optimizing Surgical Selection for Transposition With Left Ventricular Outflow Tract Obstruction. Ann Thorac Surg 2024; 117:370-377. [PMID: 37774760 DOI: 10.1016/j.athoracsur.2023.09.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 08/27/2023] [Accepted: 09/18/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Studies that have assessed the Rastelli and Nikaidoh operations for transposition of the great arteries (TGA) with obstructed left ventricular outflow tract obstruction (LVOTO) have not fully evaluated the anatomic drivers that may contribute to surgical selection. We present our procedural selection process for optimizing outcomes of complex TGA in the modern era. METHODS This is a single-center, retrospective study that included pediatric patients who underwent either a Nikaidoh or Rastelli operation for the treatment of TGA-LVOTO, congenitally corrected TGA-LVOTO, or double-outlet right ventricle TGA type-LVOTO from June 2004 to June 2021. RESULTS There were 34 patients stratified by Nikaidoh (n = 16) or Rastelli (n = 18) operation. The incidence of all postoperative complications and mortality was low, and the incidence of complications between the groups was similar. Patients were more likely to have undergone a Nikaidoh than a Rastelli if they had a pulmonary annulus >5 mm (87.5% vs 11.1%), anteriorly/posteriorly oriented great vessels (88% vs 8%), remote (80% vs 11%) or restrictive (75% vs 6%) ventricular septal defect, and right ventricular hypoplasia (50% vs 0%; all, P < .05). The resulting rates of reoperation were similar between the groups (44.0% vs 37.5%; P = .24) and largely composed of conduit replacements in the Rastelli patients and valvular repairs or replacements in the Nikaidoh group. Rates of catheter-based interventions were also similar. CONCLUSIONS These findings suggest that for the optimal treatment of conotruncal anomalies with discordant ventriculoarterial connections, procedural selection should be based on pathoanatomic criteria that can ensure patients undergo the operation most suited to their anatomy.
Collapse
Affiliation(s)
- Laura Seese
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Division of Pediatric Cardiothoracic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Carlos Diaz Castrillon
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Division of Pediatric Cardiothoracic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Luciana Da Fonseca Da Silva
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Division of Pediatric Cardiothoracic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Shwetabh Tarun
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mario Castro-Medina
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Division of Pediatric Cardiothoracic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Melita Viegas
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Division of Pediatric Cardiothoracic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jose P Da Silva
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Division of Pediatric Cardiothoracic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Victor O Morell
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Division of Pediatric Cardiothoracic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
| |
Collapse
|
2
|
Barron DJ. The Arterial Switch in the Modern Era: So Far, So Good. JACC. ADVANCES 2023; 2:100429. [PMID: 38938995 PMCID: PMC11198446 DOI: 10.1016/j.jacadv.2023.100429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- David J. Barron
- Temerty Faculty of Medicine, Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Dorobantu DM, Espuny Pujol F, Kostolny M, Brown KL, Franklin RC, Crowe S, Pagel C, Stoica SC. Arterial Switch for Transposition of the Great Arteries: Treatment Timing, Late Outcomes, and Risk Factors. JACC. ADVANCES 2023; 2:100407. [PMID: 38939004 PMCID: PMC11198700 DOI: 10.1016/j.jacadv.2023.100407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/23/2023] [Accepted: 04/06/2023] [Indexed: 06/29/2024]
Abstract
Background Reports of long-term mortality and reintervention after transposition of the great arteries with intact ventricular septum treatment, although favorable, are mostly limited to single-center studies. Even less is known about hospital resource utilization (days at hospital) and the impact of treatment choices and timing on outcomes. Objectives The purpose of this study was to describe survival, reintervention and hospital resource utilization after arterial switch operation (ASO) in a national dataset. Methods Follow-up and life status data for all patients undergoing ASO between 2000 and 2017 in England and Wales were collected and explored using multivariable regressions and matching. Results A total of 1,772 patients were identified, with median ASO age of 9.5 days (IQR: 6.5-14.5 days). Mortality and cardiac reintervention at 10 years after ASO were 3.2% (95% CI: 2.5%-4.2%) and 10.7% (95% CI: 9.1%-12.2%), respectively. The median time spent in hospital during the ASO spell was 19 days (IQR: 14, 24). Over the first year after the ASO patients spent 7 days (IQR: 4-10 days) in hospital in total, decreasing to 1 outpatient day/year beyond the fifth year. In a subgroup with complete risk factor data (n = 652), ASO age, and balloon atrial septostomy (BAS) use were not associated with late mortality and reintervention, but cardiac or congenital comorbidities, low weight, and circulatory/renal support at ASO were. After matching for patient characteristics, BAS followed by ASO and ASO as first procedure, performed within the first 3 weeks of life, had comparable early and late outcomes, including hospital resource utilization. Conclusions Mortality and hospital resource utilization are low, while reintervention remains relatively frequent. Early ASO and individualized use of BAS allows for flexibility in treatment choices and a focus on at-risk patients.
Collapse
Affiliation(s)
- Dan-Mihai Dorobantu
- Children's Health and Exercise Research Centre (CHERC), University of Exeter, Exeter, United Kingdom
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
- Cardiology Department, University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, United Kingdom
| | - Ferran Espuny Pujol
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, United Kingdom
| | - Martin Kostolny
- Heart and Lung Division, Great Ormond Street Hospital NIHR Biomedical Research Centre, London, United Kingdom
| | - Katherine L. Brown
- Heart and Lung Division, Great Ormond Street Hospital NIHR Biomedical Research Centre, London, United Kingdom
| | - Rodney C. Franklin
- Department of Paediatric Cardiology, Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom
| | - Sonya Crowe
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, United Kingdom
| | - Christina Pagel
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, United Kingdom
| | - Serban C. Stoica
- Cardiology Department, University Hospitals Bristol and Weston National Health Service Foundation Trust, Bristol, United Kingdom
| |
Collapse
|
4
|
Panayiotou A, Thorne S, Hudsmith LE, Holloway B. CT of transposition of the great arteries in adults. Clin Radiol 2021; 77:e261-e268. [PMID: 34980460 DOI: 10.1016/j.crad.2021.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 12/03/2021] [Indexed: 11/29/2022]
Abstract
Transposition of the great arteries is one of the most common cyanotic congenital heart diseases. It is characterised by an abnormal connection of the ventricles and great arteries, so that the aorta arises from the morphological right ventricle and the pulmonary artery arises from the morphological left ventricle. Historically, as with many congenital heart diseases, patients with transposition of the great arteries had poor life expectancy. Advances in surgical and medical management have resulted in patients surviving into adulthood. As these patients are living longer, they will be encountered more frequently in practice. The purpose of this article is to familiarise the general radiologist with the expected postoperative anatomy, and the appearance on cross-sectional imaging as well as the long-term complications in this group of patients.
Collapse
Affiliation(s)
- A Panayiotou
- Department of Radiology, King's College Hospital, London, UK.
| | - S Thorne
- University Health Network Toronto and University of Toronto, Ontario, Canada
| | - L E Hudsmith
- University Hospital Birmingham NHS Trust, Birmingham, UK
| | - B Holloway
- University Hospital Birmingham NHS Trust, Birmingham, UK
| |
Collapse
|
5
|
Sarıoğlu T, Doğan A, Yalçınbaş Y, Erek E, Arnaz A, Türköz R, Oktay A, Saygılı A, Altun D, Yüksek A, Boz M, Sarıoğlu A. Surgical procedures for coronary arteries in pediatric cardiac surgery: Risk factors and outcomes. J Card Surg 2021; 36:2289-2299. [PMID: 33797801 DOI: 10.1111/jocs.15547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Limited data exist regarding the coronary revascularization procedures needed during the repair of several congenital and pediatric cardiac malformations. We aimed to determine risk factors for in-hospital mortality and long-term outcomes of various pediatric coronary revascularization procedures. METHODS We retrospectively reviewed the records of 32 consecutive pediatric patients who underwent coronary revascularization procedures at our institution between May 1995 and June 2020. In-hospital mortality, risk factors, surgical indications, revascularization patency, and mid- and long-term follow-up data were investigated. Patients were categorized into the coronary artery bypass grafting (n = 11) and other coronary artery procedure (n = 21) groups. RESULTS The median age and weight of patients at the time of surgery were 9 months and 4.8 kg, respectively. There were five in-hospital deaths (5/32, 15.6%). The mortality rates were 27.2% (3/11) in the coronary artery bypass grafting group and 9.5% (2/21) in the other coronary artery procedure group (p = .206; 95% confidence interval: 0.496-25.563). The mortality rates for planned and rescue procedures were 8.3% (2/24) and 37.5% (3/8) (p = .06), respectively. The median follow-up time was 12.5 years. Control imaging studies for coronary patency were performed in 70.3% (19/27) of surviving patients. The overall coronary patency rate was 94.7% (18/19). CONCLUSIONS Pediatric coronary revascularization procedures with elective-planned indications can be performed with good outcomes. Young age and rescue and emergency procedures may carry an increased risk of in-hospital mortality, although not found to be statistically significant. Surviving patients require lifelong follow-up regarding the patency of reperfused coronary arteries.
Collapse
Affiliation(s)
- Tayyar Sarıoğlu
- Department of Cardiovascular Surgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Abdullah Doğan
- Department of Cardiovascular Surgery, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Yusuf Yalçınbaş
- Department of Cardiovascular Surgery, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Ersin Erek
- Department of Cardiovascular Surgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Ahmet Arnaz
- Department of Cardiovascular Surgery, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Rıza Türköz
- Department of Cardiovascular Surgery, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Ayla Oktay
- Department of Pediatric Cardiology, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Arda Saygılı
- Department of Pediatric Cardiology, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Dilek Altun
- Department of Anesthesiology and Reanimation, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Adnan Yüksek
- Department of Anesthesiology and Reanimation, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Murat Boz
- Department of Cardiovascular Surgery, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| | - Ayşe Sarıoğlu
- Department of Pediatric Cardiology, Acıbadem Bakırköy Hospital, İstanbul, Turkey
| |
Collapse
|
6
|
Hu F, Liang E, Zheng L, Ding L. Successful case of complex atrial flutter occurring in a patient with congenitally corrected transposition of the great arteries, aberrant left atrial appendage, and situs inversus. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2019. [DOI: 10.1186/s42444-019-0004-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Congenitally corrected transposition of great arteries (ccTGA) is a rare congenital cardiac defect with atrioventricular and ventriculoarterial discordance which leads to heart failure and limits patients’ lifespan. The extremely aberrant cardiac structure makes electrophysiological procedure and radiofrequency ablation very difficult to be performed in such patients. Until now, there were only sporadical cases that have reported the successful ablation of atrial flutter in ccTGA patients.
Case presentation
We report a case of a 36-year-old male who was diagnosed with dextrocardia, atrial septal defect and congenitally corrected transposition of great arteries (ccTGA) at a young age and received atrial septal defect repair and morphological tricuspid valve plasty in 2014. As for reasons of heart failure and atrial flutter, he frequently suffered from progressively worsening dyspnea and recurrent episodes of palpitations. Cardiac anatomic imaging reconstruction before electrophysiological test revealed an unusually huge left atrial appendage in this patient. After high-density mapping of both right atrium and left atrium, activation mapping showed reentry circuit loops were located in left atrium. Successful ablation strategy was performed under the guidance of high-density mapping and entrainment.
Conclusion
This is a clinical case showing high-density mapping and successful ablation of a complex dual-loop atrial flutter in a patient with ccTGA and aberrant left atrial appendage. The successful procedure corroborates clinical utility of high-density mapping approach in the treatment of the patients with complex congenital heart disease accompanied by rapid arrhythmia, can be simpler, safer and more effective.
Collapse
|
7
|
Dolcino A, Gaudin R, Pontailler M, Raisky O, Vouhé P, Bojan M. Single-Shot Cold Histidine-Tryptophan-Ketoglutarate Cardioplegia for Long Aortic Cross-Clamping Durations in Neonates. J Cardiothorac Vasc Anesth 2019; 34:959-965. [PMID: 31543295 DOI: 10.1053/j.jvca.2019.08.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/19/2019] [Accepted: 08/22/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE More than 30% of European pediatric cardiac surgery centers use single-dose cold histidine-tryptophan-ketoglutarate cardioplegia (Custodiol; Dr Franz Köhler Chemie GmbH, Bensheim, Germany). In neonates with transposition of the great arteries, arterial switch surgery (ASO) implies aortic division, and it is unknown whether repeated ostial cannulation causes intimal insult and affects long-term results, and therefore, single-dose Custodiol is appealing. The present study investigated the association among myocardial no-flow duration, postoperative troponins, and postoperative outcomes in neonates undergoing ASO with Custodiol cardioplegia. DESIGN Retrospective analysis of the association among myocardial no-flow duration, postoperative troponin release (concentration magnitude × measurement duration within 48 h), and outcomes using stratification according to coronary anatomy and attending surgeon. SETTING Single-institutional, tertiary pediatric cardiac surgery unit of a university hospital. PARTICIPANTS The study comprised 101 neonates undergoing ASO. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The mean age of patients was 6.1 ± 5.4 days, the cardiopulmonary bypass duration was 108.7 ± 54.1 minutes, the temperature during cross-clamping was 31.1°C ± 1.7°C, the duration of mechanical ventilation was 4 (3-6) days, the length of intensive care unit stay was 7 (5-8) days, delayed sternal closure occurred in 32 (31.7%) patients, and no patients died. The myocardial no-flow duration averaged 62.3 ± 14.6 minutes and was linked with both troponin release (p = 0.04) and low cardiac output syndrome, as assessed by the requirement for delayed sternal closure (p = 0.03), regardless of cardiopulmonary bypass duration and temperature. Eighty-two percent of the patients with myocardial no-flow duration >74 minutes necessitated delayed sternal closure. CONCLUSIONS Single-dose Custodiol may be inadequate for prolonged cross-clamping durations without myocardial perfusion in neonates.
Collapse
Affiliation(s)
- Andrea Dolcino
- Department of Anesthesiology and Critical Care, Necker-Enfants Malades University Hospital, Paris, France
| | - Regis Gaudin
- Department of Pediatric Cardiac Surgery, Necker-Enfants Malades University Hospital, Paris, France
| | - Margaux Pontailler
- Department of Pediatric Cardiac Surgery, Necker-Enfants Malades University Hospital, Paris, France; Paris Descartes University, Paris, France
| | - Olivier Raisky
- Department of Pediatric Cardiac Surgery, Necker-Enfants Malades University Hospital, Paris, France; Paris Descartes University, Paris, France
| | - Pascal Vouhé
- Department of Pediatric Cardiac Surgery, Necker-Enfants Malades University Hospital, Paris, France; Paris Descartes University, Paris, France
| | - Mirela Bojan
- Department of Anesthesiology, Congenital Cardiac Unit, Marie Lannelongue Hospital, Le Plessis Robinson, France.
| |
Collapse
|
8
|
Fate of the Left Ventricular Outflow Tract After Rastelli With Selective Infundibular Muscle Resection. Ann Thorac Surg 2018; 107:1226-1231. [PMID: 30529669 DOI: 10.1016/j.athoracsur.2018.10.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/25/2018] [Accepted: 10/29/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND The Rastelli procedure has been criticized for a high rate of left ventricular outflow tract obstruction (LVOTO) and translocation procedures have been proposed as an alternative. Infundibular resection can be performed during Rastelli to optimize the outflow tract. This study examines whether a selective policy to enlarge the outflow tract improves Rastelli outcomes across all morphological variants. METHODS Single institution 29-year experience in 105 patients. Patients were classified into transposition of the great arteries with ventricular septal defect, congenitally corrected transposition of the great arteries with ventricular septal defect, and double outlet right ventricle morphology groups. The infundibular muscle was routinely resected if prominent, in 28 cases. RESULTS Early mortality was 1.9% (2 of 105) and actuarial survival was 95.4% (95% confidence interval [CI], 89% to 99%) at 1 year, 92.9% (95% CI, 85% to 97%) at 5 years, and 84.5% (95% CI, 74% to 92%) at 10 years. The cumulative freedom from LVOTO was 99% (95% CI, 96% to 100%), 97% (95% CI, 92% to 99%), and 90% (95% CI, 88% to 96%) at 1, 5, and 10 years, respectively. The incidence was similar in all morphological groups and those undergoing infundibular resection were not at higher risk of late LVOTO. Eleven patients required surgical reoperation on the left ventricular outflow tract over a median follow-up period of 8.5 years, with no mortality, although 2 of these patients developed complete heart block. Left ventricular function was well preserved in 98.1% of all cases, including all of those requiring left ventricular outflow tract reoperation. CONCLUSIONS The Rastelli is a safe procedure that can be applied in a variety of morphological variants. LVOTO remains a late complication of Rastelli, but can be minimized by concomitant infundibular muscle resection. Late reoperation is safe and ventricular function is well preserved in greater than 95% of cases at late follow-up. The operation has stood the test of time and avoids many of the risks of translocation procedures.
Collapse
|
9
|
Emergence of the arterial switch procedure for transposition of the great arteries and the potential cost of surgical innovation. J Thorac Cardiovasc Surg 2017; 154:1047-1051. [PMID: 28412108 DOI: 10.1016/j.jtcvs.2017.03.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 02/05/2017] [Accepted: 03/10/2017] [Indexed: 11/21/2022]
|
10
|
Séguéla PE, Roubertie F, Kreitmann B, Mauriat P, Tafer N, Jalal Z, Thambo JB. Transposition of the great arteries: Rationale for tailored preoperative management. Arch Cardiovasc Dis 2016; 110:124-134. [PMID: 28024917 DOI: 10.1016/j.acvd.2016.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/03/2016] [Accepted: 11/04/2016] [Indexed: 11/17/2022]
Abstract
As preoperative morbi-mortality remains significant, care of newborns with transposition of the great arteries is still challenging. In this review of the literature, we discuss the different treatments that could improve the patient's condition into the preoperative period. Instead of a standardized management, we advocate personalized care of these neonates. Considering the deleterious effects of hypoxia, special attention is given to the use of non-invasive technologies to assess oxygenation of the tissues. As a prolonged preoperative time with low cerebral oxygenation is associated with cerebral injuries, distinguishing neonates who should undergo early surgery from those who could wait longer is crucial and requires full expertise in the management of neonatal congenital heart disease. Finally, to treat these newborns as soon as possible, we support a planned delivery policy for foetuses with transposition of the great arteries.
Collapse
Affiliation(s)
- Pierre-Emmanuel Séguéla
- Pediatric and Congenital Cardiology Unit, Bordeaux University Hospital, Bordeaux, France; Pediatric Intensive Care Unit, Bordeaux University Hospital, Bordeaux, France.
| | | | - Bernard Kreitmann
- Cardiac Surgery Unit, Bordeaux University Hospital, Bordeaux, France
| | - Philippe Mauriat
- Pediatric Intensive Care Unit, Bordeaux University Hospital, Bordeaux, France
| | - Nadir Tafer
- Pediatric Intensive Care Unit, Bordeaux University Hospital, Bordeaux, France
| | - Zakaria Jalal
- Pediatric and Congenital Cardiology Unit, Bordeaux University Hospital, Bordeaux, France
| | - Jean-Benoit Thambo
- Pediatric and Congenital Cardiology Unit, Bordeaux University Hospital, Bordeaux, France
| |
Collapse
|
11
|
Fundora MP, Aregullin EO, Wernovsky G, Welch EM, Muniz JC, Sasaki N, Hannan RL, Burke RP, Lopez L. Echocardiographic and Surgical Correlation of Coronary Artery Patterns in Transposition of the Great Arteries. CONGENIT HEART DIS 2016; 11:570-577. [PMID: 26931510 DOI: 10.1111/chd.12338] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Determine the accuracy of echocardiography to diagnose coronary anatomy in transposition of the great arteries and to evaluate the effect of accuracy on surgical outcomes and changes in accuracy over time. DESIGN Retrospective chart review of neonates admitted February 1999 to March 2013 with transposition. Coronary pattern from the preoperative echocardiogram and operative reports were collected and compared with determine diagnostic accuracy. Coronary patterns were further confirmed by intraoperative images taken during surgery. SETTING Tertiary care children's hospital. PATIENTS Neonates with transposition of the great arteries and planned arterial switch operation with an echo and operative report or image describing the coronaries. INTERVENTIONS Not applicable. OUTCOME MEASURES Accuracy of echocardiography to diagnose coronary anatomy in transposition, and to identify factors related to correct diagnosis. RESULTS One hundred forty-two patients met inclusion criteria with 122 correctly diagnosed, 16 incorrect, and 4 inconclusive. Accuracy was 86%, with 95% accuracy in patients with typical coronary patterns, 85% with the most common variant (left coronary from the leftward sinus and right and circumflex from the rightward sinus), and 61% with less common patterns. Typical and common variants were more likely to be correct than atypical patterns (P < .001). Cases with ventricular septal defect were more likely to have correctly diagnosed coronaries than with an intact ventricular septum (94% vs. 79%, P = .01). There was no change in accuracy over time (P > .05). There was no difference in duration of cardiopulmonary bypass, cross-clamp times, length of stay, or postoperative stay between the correct and incorrectly diagnosed groups (P > .05). CONCLUSIONS In our center, accuracy of echocardiographic imaging of the coronary arteries in transposition was 86% without improvement over time, and perioperative outcomes were not affected by diagnostic accuracy. Further invasive imaging may not be necessary to determine the coronary pattern in this lesion.
Collapse
Affiliation(s)
- Michael P Fundora
- Department of Pediatric Cardiology, Nicklaus Children's Hospital, Miami Children's Health System, Florida International University, Herbert Wertheim College of Medicine, Miami, Fla, USA
| | - Enrique Oliver Aregullin
- Department of Pediatric Cardiology, Nicklaus Children's Hospital, Miami Children's Health System, Florida International University, Herbert Wertheim College of Medicine, Miami, Fla, USA
| | - Gil Wernovsky
- Department of Pediatric Cardiology, Nicklaus Children's Hospital, Miami Children's Health System, Florida International University, Herbert Wertheim College of Medicine, Miami, Fla, USA
| | - Elizabeth M Welch
- Department of Pediatric Cardiology, Nicklaus Children's Hospital, Miami Children's Health System, Florida International University, Herbert Wertheim College of Medicine, Miami, Fla, USA
| | - Juan-Carlos Muniz
- Department of Pediatric Cardiology, Nicklaus Children's Hospital, Miami Children's Health System, Florida International University, Herbert Wertheim College of Medicine, Miami, Fla, USA
| | - Nao Sasaki
- Department of Pediatric Cardiology, Nicklaus Children's Hospital, Miami Children's Health System, Florida International University, Herbert Wertheim College of Medicine, Miami, Fla, USA
| | - Robert L Hannan
- Department of Cardiovascular Surgery, Nicklaus Children's Hospital, Miami Children's Health System, Florida International University, Herbert Wertheim College of Medicine, Miami, Fla, USA
| | - Redmond P Burke
- Department of Cardiovascular Surgery, Nicklaus Children's Hospital, Miami Children's Health System, Florida International University, Herbert Wertheim College of Medicine, Miami, Fla, USA
| | - Leo Lopez
- Department of Pediatric Cardiology, Nicklaus Children's Hospital, Miami Children's Health System, Florida International University, Herbert Wertheim College of Medicine, Miami, Fla, USA
| |
Collapse
|
12
|
Paul S, Resnick S, Gardiner K, Ramsay JM. Long-distance transport of neonates with transposition of the great arteries for the arterial switch operation: A 26-year Western Australian experience. J Paediatr Child Health 2015; 51:590-4. [PMID: 25425073 DOI: 10.1111/jpc.12782] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 11/29/2022]
Abstract
AIM There is evidence that outcomes of complex paediatric cardiac procedures including the arterial switch operation (ASO) for transposition of the great arteries (TGA) are improved when performed at higher volume centres. While in utero transport for surgery is considered ideal, antenatal detection rates of TGA are low. Long-distance transport of post-natally diagnosed neonates has the potential to destabilise the patient's clinical condition. Since 1986, many neonates with TGA have been transported interstate from Perth to Melbourne or Brisbane for ASO surgery. The aim of this study was to review the Western Australian experience of interstate transport of newborns with TGA for ASO, noting transport complications and comparing the early mortality of these patients with published outcomes of the ASO from Royal Children's Hospital (RCH), Melbourne. METHOD In this retrospective cohort study, we reviewed the neonatal and cardiology databases and medical records to identify infants with TGA born between 1986 and 2011 and requiring ASO surgery during the neonatal period. RESULTS Over 26 years, 80 neonates were transferred interstate for ASO surgery. Twelve infants required ventilation, 36 needed prostaglandin (prostaglandin E1) infusion and 3 inotropic support. There was no mortality during transport and there was a single early post-operative death. This early mortality of 1.2% compares favourably with the RCH mortality of 2.8% from a recently published review of early outcomes for ASO. CONCLUSIONS When in utero transport is not possible, long-distance transport of neonates with TGA can be safely undertaken, with no evidence of increased transport mortality/ major morbidity or higher early surgical mortality.
Collapse
Affiliation(s)
- Saritha Paul
- Neonatology Clinical Care Unit, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Steven Resnick
- Neonatology Clinical Care Unit, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,Centre for Neonatal Research and Education, University of Western Australia, Perth, Western Australia, Australia.,Newborn Emergency Transport Service, Perth, Western Australia, Australia
| | - Katharine Gardiner
- Neonatology Clinical Care Unit, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - James M Ramsay
- Children's Cardiac Centre, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| |
Collapse
|
13
|
Wagner R, Vollroth M, Daehnert I, Kostelka M. First successful repair of an aortico-to-right ventricular tunnel (ARVT) in d-transposition of the great arteries with aortic valve atresia and ventricular septal defect. Pediatr Cardiol 2015; 36:880-3. [PMID: 25645097 DOI: 10.1007/s00246-015-1123-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 01/26/2015] [Indexed: 11/27/2022]
Abstract
The presented case reports on the first successful complex biventricular repair in a neonate with an aortico-to-right ventricular tunnel and dextrotransposition of the great arteries complicated by aortic atresia.
Collapse
Affiliation(s)
- Robert Wagner
- Department of Paediatric Cardiology, University of Leipzig-Heart Center, Struempellstrasse 39, 04289, Leipzig, Germany,
| | | | | | | |
Collapse
|
14
|
Jacobs JP, Maruszewski B. Functionally univentricular heart and the fontan operation: lessons learned about patterns of practice and outcomes from the congenital heart surgery databases of the European association for cardio-thoracic surgery and the society of thoracic surgeons. World J Pediatr Congenit Heart Surg 2014; 4:349-55. [PMID: 24327626 DOI: 10.1177/2150135113494228] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND "The term "functionally univentricular heart" describes a spectrum of congenital cardiovascular malformations in which the ventricular mass may not readily lend itself to partitioning that commits one ventricular pump to the systemic circulation and another to the pulmonary circulation." The purpose of this article is to review patterns of practice and outcomes in the Congenital Heart Surgery Databases (CHSDBs) of the European Association for Cardio-Thoracic Surgery (EACTS) and the Society of Thoracic Surgeons (STS) in patients with functionally univentricular hearts undergoing the Fontan operation. METHODS We examined all index operations performed on patients with functionally univentricular hearts in the EACTS and STS-CHSDBs over 4 years from 2007 to 2010, inclusive. RESULTS The most common diagnostic categories are hypoplastic left heart syndrome, tricuspid atresia, and double inlet left ventricle. The Fontan operation makes up 3.2% of all cardiac operations in the EACTS and STS-CHSDBs over 4 years from 2007 to 2010, inclusive. Of all the patients undergoing a Fontan procedure, 65.1% had an extracardiac Fontan, 21.5% had a lateral tunnel, and 5.8% had a Fontan revision or conversion (Re-do Fontan). In operations where fenestration status is known, 68.5% of the Fontan operations were fenestrated. During the four years of this analysis, only 5 patients had ventricular septation. Exclusive of Fontan revision or conversion (Re-do Fontan), all remaining Fontan operations had a discharge mortality of 2.3%. Fontan revision or conversion (Re-do Fontan) had a discharge mortality of 12.8%. CONCLUSIONS The STS database is largest CHSDB in North America. The EACTS database is largest CHSDB in Europe. This review of data from EACTS and STS allows for unique documentation of practice patterns and outcomes. From this analysis, it is clear that patients with functionally univentricular hearts present a challenging problem; however, exclusive of Fontan revision or conversion (Re-do Fontan), the Fontan operation has a discharge mortality of 2.3%.
Collapse
Affiliation(s)
- Jeffrey Phillip Jacobs
- Johns Hopkins Children's Heart Surgery, All Children's Hospital and Florida Hospital for Children, Saint Petersburg, Tampa, and Orlando, FL, USA
| | | |
Collapse
|
15
|
Anderson BR, Ciarleglio AJ, Hayes DA, Quaegebeur JM, Vincent JA, Bacha EA. Earlier Arterial Switch Operation Improves Outcomes and Reduces Costs for Neonates With Transposition of the Great Arteries. J Am Coll Cardiol 2014; 63:481-7. [DOI: 10.1016/j.jacc.2013.08.1645] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 08/06/2013] [Indexed: 10/26/2022]
|
16
|
Wilkinson JL, Anderson RH. Anatomy of discordant atrioventricular connections. World J Pediatr Congenit Heart Surg 2013; 2:43-53. [PMID: 23804932 DOI: 10.1177/2150135110383878] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The term discordant atrioventricular connections refers to the situation in which the ventricles are connected inappropriately to the atrial chambers. In most instances, the connections of the great arteries are also abnormal, with the aorta and the pulmonary trunk arising from morphologically inappropriate ventricles. This combination results in the presence of so-called congenitally corrected transposition. Double-outlet right ventricle is occasionally present, while concordant ventriculoarterial connections may be seen rarely. Most such hearts have a range of additional abnormalities, including ventricular septal defects; outflow tract obstruction, usually of the morphologically left ventricle; anomalies of the morphologically tricuspid valve; and a highly abnormal location of the specialized atrioventricular conduction axis. Some examples exhibit bizarre abnormalities of ventricular relationships and topology, including criss-cross atrioventricular connections and superoinferior ventricular relations. In describing the anatomy of these malformations, it is important to use a step-by-step segmental approach to the documentation of the connections and associated defects in each case and to avoid potentially confusing shorthand terms.
Collapse
|
17
|
Morbidity of the arterial switch operation. Ann Thorac Surg 2012; 93:1977-83. [PMID: 22365263 DOI: 10.1016/j.athoracsur.2011.11.061] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 11/23/2011] [Accepted: 11/29/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND The arterial switch operation (ASO) has become a safe, reproducible surgical procedure with low mortality in experienced centers. We examined morbidity, which remains significant, particularly for complex ASO. METHODS From 2003 to 2011, 101 consecutive patients underwent ASO, arbitrarily classified as "simple" (n=52) or "complex" (n=49). Morbidity was measured in selected complications and postoperative hospitalization. Three outcomes were analyzed: ventilation time, postextubation hospital length of stay, and a composite morbidity index, defined as ventilation time+postextubation hospital length of stay+occurrence of selected major complications. Complexity was measured with the comprehensive Aristotle score. RESULTS The operative mortality was zero. Twenty-five major complications occurred in 23 patients: 6 of 25 (12%) in simple ASO and 19 of 49 (39%) in complex ASO (p=0.002). The most frequent complication was unplanned reoperation (15 vs 6, p=0.03). No patients required permanent pacing. The complex group had a significantly higher morbidity index and longer ventilation time and postextubation hospital length of stay. In multivariate analysis, factors independently predicting higher morbidity were the comprehensive Aristotle score, arch repair, bypass time, and malaligned commissures. Myocardial infarction caused one sudden late death at 3 months. Late coronary failure was 2%. Overall survival was 99% at a mean follow-up of 49±27 months. CONCLUSIONS In this consecutive series without operative mortality, morbidity was significantly higher in complex ASO. The only anatomic incremental risk factors for morbidity were aortic arch repair and malaligned commissures, but not primary diagnosis, weight less than 2.5 kg, or coronary patterns.
Collapse
|
18
|
Leon-Wyss J, Rito ML, Barnoya J, Castañeda AR. Persistent Institutional Difficulties in Surgery for Transposition of the Great Arteries in Guatemala: Analysis With the Aristotle Basic and Comprehensive Scores. World J Pediatr Congenit Heart Surg 2011; 2:346-50. [DOI: 10.1177/2150135111406291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Neonates with complex congenital cardiac lesions are largely inadequately managed in Guatemala. Methods. Between 1997 and 2009, 79 patients who underwent operations for transposition of the great arteries were identified; 51 (63.3%) had an arterial switch operation (ASO) and 28 (36%) an atrial switch operation (ATSO). The Aristotle Basic Complexity score (ABC score) and the Aristotle Comprehensive Complexity score (ACC score) have been used to aid in the evaluation of quality of care associated with pediatric cardiac surgery by adjusting for operative complexity. Results. In-hospital mortality was 47% for the ASO and 25% for the ATSO group; 36.7% were beyond 1 month of age and many exhibited increased preoperative risk factors. The mean ABC score was 9.75 ± 0.89 and the ACC score was 12.12 ± 2.7, with a mean 2.36-point increase ( P < .05). Comparing survivors and nonsurvivors with both scores, significant differences were identified (ABC: P < .04 and ACC: P < .02). Conclusion. During this 13-year period, a low volume of surgery for transposition of the great arteries (TGA) was performed at our institution with a relatively high surgical mortality. Many patients with TGA in Guatemala are either never referred for surgery or referred late. Strategies to improve outcomes for neonates with TGA in Guatemala must include increases in early diagnosis countrywide and prompt referral to our unit. Based on the larger number of neonates with TGA that would be referred to our center, we anticipate that this strategy should substantially improve surgical outcomes and favor overall team-related skills.
Collapse
Affiliation(s)
- Juan Leon-Wyss
- Pediatric Cardiac Surgery Unit of Guatemala (UNICARP), Guatemala, Centro America
| | - Mauro Lo Rito
- Pediatric Cardiac Surgery Unit of Guatemala (UNICARP), Guatemala, Centro America
| | - Joaquin Barnoya
- Pediatric Cardiac Surgery Unit of Guatemala (UNICARP), Guatemala, Centro America
| | - Aldo R. Castañeda
- Pediatric Cardiac Surgery Unit of Guatemala (UNICARP), Guatemala, Centro America
| |
Collapse
|
19
|
Jacobs JP, Pasquali SK, Morales DLS, Jacobs ML, Mavroudis C, Chai PJ, Tchervenkov CI, Lacour-Gayet FG, Walters H, Quintessenza JA. Heterotaxy: lessons learned about patterns of practice and outcomes from the congenital heart surgery database of the society of thoracic surgeons. World J Pediatr Congenit Heart Surg 2011; 2:278-86. [PMID: 23804985 PMCID: PMC3695419 DOI: 10.1177/2150135110397670] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
According to The International Society for Nomenclature of Pediatric and Congenital Heart Disease (ISNPCHD), "Heterotaxy is synonymous with 'visceral heterotaxy' and 'heterotaxy syndrome'. Heterotaxy is defined as an abnormality where the internal thoraco-abdominal organs demonstrate abnormal arrangement across the left-right axis of the body. By convention, heterotaxy does not include patients with either the expected usual or normal arrangement of the internal organs along the left-right axis, also known as 'situs solitus', or patients with complete mirror-imaged arrangement of the internal organs along the left-right axis also known as `situs inversus'." or patients with complete mirror-image arrangement of the internal organs along the left-right axis, also known as situs inversus. The purpose of this article is to review the data about heterotaxy in the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database. The investigators examined all index operations in the STS Congenital Heart Surgery Database over 12 years from January 1, 1998 to December 31, 2009, inclusive. This analysis resulted in a cohort of 77 153 total index operations. Of these, 1505 operations (1.95%) were performed in patients with heterotaxy. Of the 1505 index operations performed in patients with heterotaxy, 1144 were in patients with asplenia and 361 were in patients with polysplenia. In every STS -EACTS Congenital Heart Surgery Mortality Category, discharge mortality is higher in patients with heterotaxy compared with patients without heterotaxy (EACTS = European Association for Cardio-Thoracic Surgery). Discharge mortality after systemic to pulmonary artery shunt is 6.6% in a cohort of all single-ventricle patients except those with heterotaxy, whereas it is 10.8% in single-ventricle patients with heterotaxy. Discharge mortality after Fontan is 1.8% in a cohort of all single-ventricle patients except those with heterotaxy, whereas it is 4.2% in single-ventricle patients with heterotaxy. The STS Congenital Heart Surgery Database is largest congenital heart surgery database in North America. This review of data from the STS Congenital Heart Surgery Database allows for unique documentation of practice patterns and outcomes. From this analysis, it is clear that heterotaxy is a challenging problem with increased discharge mortality in most subgroups.
Collapse
Affiliation(s)
- Jeffrey Phillip Jacobs
- The Congenital Heart Institute of Florida (CHIF), All Children's Hospital and Children's Hospital of Tampa, University of South Florida College of Medicine, Cardiac Surgical Associates of Florida (CSAoF), Saint Petersburg and Tampa, FL, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|