Cited 16 times since 2012 (1.3 per year) source: EuropePMC European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Volume 42, Issue 3, 13 2 2012, Pages 520-523 Arterial switch in the first hours of life: no need for Rashkind septostomy? Nevvazhay T, Chernogrivov A, Biryukov E, Biktasheva L, Karchevskaya K, Sulejmanov S, Kalinicheva J, Artemiev N
Objectives
We describe our experience of arterial switch operation (ASO) in the first hours of life in children with D-transposition of the great arteries (TGA) intact ventricular septum and restrictive patent foramen ovale (PFO) with severe metabolic disorders. The Rashkind procedure is the usual strategy to stabilize critically ill patient before surgery. We assume that primary ASO is also the safe option.
Methods
Between 2008 and 2010, 44 neonates underwent ASO. Of these, eight with simple D-TGA had severe acid-base disorders and form the subject of this report. All were operated on within the first 24 h of life. Median time from birth to admission to the hospital was 4 h 52 min. All patients had prenatal diagnoses. In six cases, childbirths were held in a maternity hospital near the heart surgery centre. In two cases, patients were transported from remote hospitals. All patients received prostaglandin E(l), three of them required ventilator support. All patients had small PFO (1-3 mm), oxygen saturation 60-85%. All had metabolic acidosis (pH ranging 6.96-7.2); lactate was increased in all patients (ranging 5.5-17.0 mmol/l).
Results
All patients underwent primary ASO. We used normothermic cardiopulmonary bypass (CPB). Median CPB time was 143 min, and median ischaemic time was 68 min. All patients had uneventful postoperative periods. There were no in-hospital deaths and no late deaths after hospital discharge.
Conclusions
ASO for D-TGA in the first hours of life is a good option for the treatment of critically ill neonates with metabolic disorders. In our experience, there is no need for the Rashkind procedure to stabilize the patient before surgery.
