Usefulness of continuous transesophageal echocardiographic (TEE) monitoring during the weaning period from cardiopulmonary bypass in children

Abstract

The arterial switch operation (ASO) has become the procedure of choice for the transposition of great arteries (TGA) and double outlet right ventricle (DORV) Taussig – Bing anomaly. The improvement in diagnosis, surgical techniques, and peri-operative management resulted in improvement in mortality and morbidity. The objective of this study was to evaluate the preoperative demographic, morphological and operative variables that affect the early outcome of the arterial switch procedure.This is a retrospective study of 85 patients who underwent ASO in children's cardiovascular program (Deutsches Herzzentrum, Berlin) between august 2012 and October 2015. It included all patients underwent ASO for D-TGA or DORV. Preoperative, operative and postoperative variable were studied and analyzed for their correlation to unfavorable early postoperative outcome [mortality or high morbidity such as need for extra-corporeal membrane oxygenation (ECMO), occurrence of coronary events and reoperation or catheter intervention].There were 3 (3,5%) early deaths in our study; 2 due to coronary ischemic events and one due to low cardiac output. Five coronary events and 17 early reoperations or catheter interventions were recorded. Several risk factors were associated with unfavorable outcome as low birth weight patients (P-value = 0.03), preoperative corticosteroid intake (P-value = 0,046), intramural course of coronary arteries (P-value = 0.04), but retropulmonary course and mono-coronary ostium had no correlation to unfavorable outcome. There was no correlation between having simultaneous operative procedure and the unfavorable outcome (P-value = 0.9). The predictors of unfavourable outcome included prolonged ischemic time (P-value = 0.000), prolonged cardiopulmonary bypass time, prolongation of the ventilation time and increasing amount of postoperative bleeding (P-value = 0,000). The increase in the ischemic time had a strong statistical correlation with the increased inotropic support in the postoperative period (P-value = 0.002).ASO can be performed without excess mortality. Simultaneous aortic arch repair can be done with no extra mortality. Prematurity, low birth weight, Taussig-Bing anomaly, intramural coronary artery course and some other coronary abnormalities, aortic cross clamp time and bypass time were risk factors for unfavourable outcome.