Original article
Congenital heart surgery
Outcomes of the Arterial Switch Operation in Children Less Than 2.5 Kilograms

https://doi.org/10.1016/j.athoracsur.2016.11.079Get rights and content

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.

Section snippets

Patients

From 1983 to 2014, 870 patients with transposition of the great arteries (TGA) or Taussig-Bing anomaly underwent an ASO for biventricular repair at the Royal Children’s Hospital. Thirty-one patients (3.6%, 31 of 870) weighed less than 2.5 kg at ASO. Mean weight at ASO for the less than 2.5 kg patients was 2.1 kg (median 2.1; range, 1.1 to 2.4). Twenty-nine patients underwent an ASO for TGA, and 2 patients had an ASO for Taussig-Bing anomaly. Mean age at operation was 16 days (median 11; range,

Early Outcomes

Preoperative and operative data are summarized in Table 1.

Comment

Despite considerable progress in pediatric cardiac surgery, LBW remains a risk factor for mortality in major pediatric cardiac operations 3, 4, 5. Low body weight infants are often premature and may have complications related to prematurity affecting various systems [6]. Organ immaturity places these infants at a higher risk of infection, renal failure, respiratory disease, cerebral hemorrhage, and necrotizing enterocolitis, to name but a few [1]. Cardiopulmonary bypass is a significant insult

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