Outcomes of the Arterial Switch Operation in Children Less Than 2.5 Kilograms.

Abstract

BACKGROUND:

Children with body weight less than 2.5 kg who undergo the arterial switch operation (ASO) represent a challenging group. We sought to determine outcomes of patients with weight less than 2.5 kg at ASO at a single institution.

METHODS:

All patients who underwent an ASO with biventricular repair and weighed less than 2.5 kg at time of surgery were identified from the hospital database and reviewed retrospectively.

RESULTS:

From 1983 to 2014, 870 patients underwent an ASO with biventricular repair at our institution. At the time of ASO, 31 patients (3.6%, 31 of 870) weighed less than 2.5 kg (mean 2.1; median 2.1; range, 1.1 to 2.4). Twenty-nine patients underwent an ASO for d-transposition of the great arteries, and 2 patients had an ASO for Taussig-Bing anomaly. Mean age at operation was 16 days (median 11; range, 3 to 66). There were 6 hospital deaths (19%, 6 of 31) among patients weighing less than 2.5 kg compared with a hospital mortality of 1.9% (16 of 839) among patients weighing more than 2.5 kg (p < 0.0001). Mortality for children weighing 2.0 kg or less was 50% (5 of 10) compared with a mortality of 2.8% (1 of 21) for children weighing more than 2.0 kg but less than 2.5 kg. Four patients (13%, 4 of 31) required reoperation during hospital admission. Follow-up was available for 24 survivors (96%, 24 of 25). Mean follow-up was 13.2 years (median 11.9; range, 6 months to 25 years). There were no late deaths. Two patients (8%, 2 of 24) required late reoperation. No patient had more than mild neoaortic valve regurgitation, and all survivors were in New York Heart Association class I at last follow-up.

CONCLUSIONS:

Early mortality for children weighing less than 2.5 kg undergoing the ASO remains high; however, most of the mortality occurred in children weighing 2.0 kg or less. Long-term outcomes for survivors are excellent.

• Authors: Tyson A Fricke, Anne Eva Bulstra, Benjamin R Loyer, Robert G Weintraub, Yves d'Udekem, Christian P Brizard, Igor E Konstantinov
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 103 Issue 3 Pg. 840-844 (Mar 2017) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 28168965 (Publication Type: Journal Article)
• Copyright: Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Topics

• Arterial Switch Operation (mortality)
• Hospital Mortality
• Humans
• Infant
• Infant, Low Birth Weight
• Infant, Newborn
• Reoperation
• Treatment Outcome