Anaesthetic management and outcomes in patients with surgically corrected D-transposition of the great arteries undergoing non-cardiac surgery

Abstract

Patients with effective repair of D-transposition of the great arteries (D-TGA) increasingly present for non-cardiac surgery. These patients may be predisposed to heart failure, arrhythmias, and sudden death, especially after the atrial switch repair. This retrospective study was undertaken to review the care and outcomes of patients with D-TGA who presented for non-cardiac surgery. Records for patients with surgically corrected D-TGA undergoing general anaesthesia for non-cardiac surgery between October 2000 and April 2008 were reviewed. The anaesthesiology records, operative note, admission history and physical examination records, and discharge summaries of these patients were reviewed and the following data collected: patient characteristics; comorbidities; surgical procedure; anaesthetic and monitoring techniques; intra- and postoperative complications; and admission status. Fifty procedures, including 43 in the paediatric setting and seven in the adult setting, comprised the final sample. The majority of these patients received anaesthesia on an outpatient basis in the paediatric hospital, without invasive monitoring and without complication. There were four adverse events including a significant bradycardia, failed extubation after two of the procedures, and postoperative bleeding requiring return to the operating theatre in another. Data suggest that the majority of patients with surgically corrected D-TGA can safely undergo general anaesthesia, often as outpatients, with no invasive monitoring. However, given the incidence of adverse events, it remains imperative that the perioperative care be individualized based on the presence of comorbidities, type of repair, residual cardiac disease, severity of planned surgery, and experience of the provider.