Perioperative Factors and Radiographic Severity Scores for Predicting the Duration of Mechanical Ventilation After Arterial Switch Surgery

Abstract

ObjectivesCardiac surgery on cardiopulmonary bypass (CPB) during the neonatal period can cause perioperative organ injuries. The primary aim of this study was to determine the incidence and risk factors associated with postoperative mechanical ventilation duration and acute lung injury following arterial switch operation (ASO). The secondary aim was to examine the utility of the Brixia score for characterizing postoperative acute lung injury (ALI).Design: A retrospective study. SettingA single-center university hospital. ParticipantsA total of 93 neonates with transposition of great arteries with intact ventricular septum (dTGA/IVS) underwent ASO. InterventionsNone Measurements and Main ResultsFrom January 2015 to December 2022, 93 neonates with dTGA/IVS were included in the study. The cohort had a median age of 4.0 (3.0-5.0) days and a mean weight of 3.3 ± 0.5 kg. About 63% of patients had ≥ 48 hours postoperative mechanical ventilation after ASO. Risk factors included prematurity, post-CPB transfusion of salvaged red cells, platelets and cryoprecipitate, and postoperative fluid balance by univariate analysis. The larger transfused platelet volume was associated with the risk of ALI by multivariate analysis. The median baseline Brixia scores were 11.0 (9.0-12.0) and increased significantly in the postoperative day 1 in patients who developed moderate ALI 24 hours after admission to the intensive care unit (15.0 (13.0-16.0) vs. 12.0 (10.0-14.0), p = 0.046). ConclusionsArterial switch operation results in a high incidence of ≥ 48-hour postoperative mechanical ventilation. Blood component transfusion is a potentially modifiable risk factor. The Brixia scores may also be used to characterize postoperative acute lung injury.