Moderate Versus Deep Hypothermia for Arterial Switch Operation

Abstract

Background: We evaluated the impact of moderate versus deep intraoperative hypothermia on postoperative morbidity in patients receiving a standard arterial switch operation (ASO). Methods: 71 newborns underwent ASO from 9/98 onwards. Patients were operated using moderate hypothermia (M, 24 °C to 30 °C, n = 21) or deep hypothermia (D, 16 - 22 °C, n = 50). Mean patient age was 9.5 (M) versus 10 (D) days, body weight 3.6 ± 0.7 (M) versus 3.8 ± 0.9 kg (D), p = n. s. Coronary anatomy was complex in 9.5 % (M) versus 16 % (D) of patients; additional VSD was present in 23.8 (M) versus 38 % (D) of the patients, respectively. Mean follow-up is 2.3 ± 1.6 years. Results: Intraoperative rectal temperature was 25 ± 2 °C (M) and 19 ± 2 °C (D). Cross-clamping time was 95 ± 24 (M) versus 108 ± 31 min (D), p = n. s. Conventional ultrafiltration was performed at 114 ± 46 (M) versus 129 ± 69 ml/kg (D), p = n. s. One patient (D) with complex anatomy suffered myocardial ischemia required ECMO support and died. In-hospital mortality was 1.4 %. All other patients were safely weaned from extracorporeal circulation with moderate inotropic support. Secondary chest closure was performed in 33 % (M) versus 54 % (D) of the patients. Patients were extubated after 7.4 (M) versus 6 (D) days. There was no renal failure and no other serious complications. Conclusions: ASO can be safely performed using moderate hypothermia, even with complex anatomy, leading to comparatively good results compared to a conventional approach.

Key words

Arterial switch operation - transposition of the great arteries - moderate hypothermia

References

• 1 Daebritz S H, Nollert G, Sachweh J S, Engelhardt W, von Bernuth G, Messmer B J. Anatomical risk factors for mortality and cardiac morbidity after arterial switch operation.  Ann Thorac Surg. 2000;  69 1880-1886
• 2 Kang N, de Leval M R, Elliott M, Tsang V, Kocyildirim E, Sehic I, Foran J, Sullivan I. Extending the boundaries of the primary arterial switch operation in patients with transposition of the great arteries and intact ventricular septum.  Circul. 2004;  110 (Suppl 2) II-123-II-127
• 3 Jacobs J P, Lacour-Gayet F G, Jacobs M L, Clarke D R, Tchervenkov C I, Gaynor W, Spray T L, Maruszewski B, Stellin G, Gould J, Dokholyan R S, Peterson E D, Elliott M J, Mavroudis C. Initial application in the STS congenital database of complexity adjustment to evaluate surgical case mix and results.  Ann Thorac Surg. 2005;  79 1635
• 4 Karl T R, Hall S, Ford G, Kelly E A, Brizard C PR, Mee R BB, Weintraub R G, Cochrane A D, Glidden D. Arterial switch with full-flow cardiopulmonary bypass and limited circulatory arrest: neurodevelopmental outcome.  J Thorac Cardiovasc Surg. 2004;  127 213
• 5 Lecompte Y, Zannini L, Hazan E, Jareau M M, Bex J P, Tu T V, Neveux J Y. Anatomic correction of transposition of the great arteries.  J Thorac Cardiovasc Surg. 1981;  82 629-631
• 6 Norwood W I, Dobell A R, Freed M D, Kirklin J W, Blackstone E H. Intermediate results of the arterial switch repair. A 20-institution study.  J Thorac Cardiovasc Surg. 1988;  96 854-863
• 7 Yacoub M H, Radley-Smith R, Maclaurin R. Two-stage operation for anatomical correction of transposition of the great arteries with intact ventricular septum.  Lancet. 1977;  1 1275-1278
• 8 Williams W G, McCrindle B W, Ashburn D A, Jonas R A, Mavroudis C, Blackstone E H. Congenital Heart Surgeon's Society . Outcomes in 829 neonates with compete transposition of the great arteries 12 - 17 years after repair.  Eur J Cardiothorac Surg. 2003;  24 1-9
• 9 Wernovsky G, Mayer J E, Jonas R A, Hanley F L, Blackstone E H, Kirklin J W, Castaneda A R. Factors influencing early and late outcome of the arterial switch operation for transposition of the great arteries.  J Thorac Cardiovasc Surg. 1995;  109 289-301
• 10 Bellinger D C, Wypij D, du Duplessis A J, Rappaport L A, Jonas R A, Wernovsky G, Newburger J W. Neurodevelopmental status at eight years in children with dextro-transposition of the great arteries: The Boston circulatory arrest trial.  J Thorac Cardiovasc Surg. 2003;  126 1385-1396
• 11 Hovels-Gurich H H, Seghaye M C, Daebritz S, Messmer B J, von Bernuth G. Cognitive and motor development in preschool and school-aged children after neonatal arterial switch operation.  J Thorac Cardiovasc Surg. 1997;  114 578-585
• 12 Gomelsky A, Holden E W, Ellerbeck K A, Brenner J I. Predictors of developmental outcomes in children with complete transposition.  Cardiol Young. 1998;  8 352-357
• 13 Hovels-Gurich H H, Seghaye M C, Schnitker R, Wiesner M, Huber W, Minkenberg R, Kotlarek F, Messmer B J, von Bernuth G. Long-term neurodevelopmental outcomes in school-aged children after neonatal arterial switch operation.  J Thorac Cardiovasc Surg. 2002;  124 448-458
• 14 Hovels-Gurich H H, Seghaye M C, Ma Q, Miskova M, Minkenberg R, Messmer B J, von Bernuth G. Long-term results of cardiac and general health status in children after neonatal arterial switch operation.  Ann Thorac Surg. 2003;  75 935-943
• 15 Williams W G, Quaegebeur J M, Kirklin J W, Blackstone E H. Outflow obstruction after the arterial switch operation: a multiinstitutional study. Congenital Heart Surgeons Society.  J Thorac Cardiovasc Surg. 1997;  114 975-987