Emergency Arterial Switch Operation for Transposition of the Great Arteries as an alternative to ECMO

  • Dr Jonathan Mervis, Paediatric and congenital cardiac services Starship Children's Hospital, New Zealand
  • Dr Kirsten Finucane, Starship Children's Hospital, New Zealand
  • Dr John Beca, Paediatric Intensive Care Unit Starship Children's Hospital, New Zealand
  • Dr Thomas Gentles, Paediatric and congenital cardiac services Starship Children's Hospital, New Zealand

    • Background:
    A significant minority of newborns with Transposition of the Great Arteries (TGA) remain severely hypoxaemic despite Balloon Atrial Septostomy, prostaglandin and pulmonary vasodilators. We have adopted a strategy of urgent arterial switch operations (ASO) in these infants rather than ECMO.
    Methods:
    Infants with TGA and an inability to achieve stable oxygen saturations > 65% and haemodynamic stability after intensive medical therapy were included in this study. Between 1996-2008 twenty-one (8%) of 265 infants with TGA fitted this criteria.Pre-operative and operative management, and outcome were detailed for this subset. Results were compared to infants undergoing elective ASO and international data for cardiac infants treated with ECMO.
    Results:
    There were two (9.5%) early post operative deaths. Mean follow up was 3.4yrs with no late deaths.The mean ICU duration was 7.2 days and mean hospital stay 15 days.Two patients required post-operative ECMO.This compared to an overall early mortality for TGA of 2.3% and a survival of 38% in cardiac neonates treated with ECMO(international registry) over the same time period.
    Conclusion:
    Emergency ASO rescues infants with TGA and severe hypoxaemia unresponsive to treatment and should be considered as an alternative to pre-operative ECMO.