Arterial Switch Operation in Late Presenters with Transposition of Great Arteries and Intact Ventricular Septum: How Late is Late?

  • Prof Anita Saxena, All India Institute of Medical Sciences, New Delhi, India, India
  • Dr Akshay Bisoi, All India Institute of Medical Sciences, New Delhi, India, India
  • Prof Sandeep Chauhan, All India Institute of Medical Sciences, New Delhi, India, India
  • Dr Srikrishna Reddy, All India Institute of Medical Sciences, New Delhi, India, India
  • Dr Pranav Sharma, All India Institute of Medical Sciences, New Delhi, India, India
  • Dr Rajnish Juneja, All India Institute of Medical Sciences, New Delhi, India, India
  • Prof Shyam Kothari, All India Institute of Medical Sciences, New Delhi, India, India
  • Dr S Ramakrishnan, All India Institute of Medical Sciences, New Delhi, India, India

    • Objective: Patients with transposition of great arteries and intact ventricular septum (TGA IVS) who present late for surgery are considered high risk for primary arterial switch operation (ASO). However late presentation is not unusual in several parts of the world. This study reports our experience in patients with TGA IVS presenting beyond six weeks of life who underwent primary ASO.

    Methods: Hospital records of patients who underwent ASO for TGA IVS beyond 6 weeks of life over the last 4 years were reviewed for preoperative information including echocardiography. Outcomes were measured as in-hospital mortality and need for extra corporeal membrane oxygenator (ECMO) in postoperative period.

    Results: Out of a total of 185 ASO procedures, 32 were performed at age > 6 weeks for TGA IVS (17.3%). The age ranged from 42 days to 9 years (median 60 days). Subvalvular LV outflow obstruction was present in 5 cases. 20 cases had been recently treated with antibiotics for sepsis and / or respiratory tract infection. Echo revealed a favorable geometry of LV in 22 cases and a borderline LV in 10 cases. In-hospital mortality was 21.8% (7/32), LV geometry was borderline in 4/7 cases. The length of stay in ICU and hospital was 4 and 18 days respectively. ECMO support was required in 4.

    Conclusion: Our data shows that in select cases of TGA IVS presenting late, primary ASO can be performed successfully. Accurate assessment of LV by echo is crucial to make this decision. Some patients may require ECMO support.