TY - JOUR
T1 - Five-year experience with immediate extubation after arterial switch operations for transposition of great arteries
AU - Varghese, Joby
AU - Kutty, Shelby
AU - Moukagn, Karl Stessy Bisselou
AU - Craft, Mary
AU - Abdullah, Ibrahim
AU - Hammel, James M.
N1 - Publisher Copyright:
© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
PY - 2017/4/1
Y1 - 2017/4/1
N2 - OBJECTIVES: We sought to identify preoperative, intraoperative and anatomical factors associated with immediate extubation (IE) after arterial switch operation for d-transposition of great arteries (dTGA). METHODS: This was a single-centre retrospective study performed from 1 January 2010 to 30 June 2015. IE was defined as successful extubation in the operating room (OR). Univariate/bivariate regression of preoperative, intraoperative and anatomical variables was used to determine associations with IE. RESULTS: Of 32 patients in the dTGA spectrum (age at operation 6 days), 18 (56%) underwent IE. Twelve (71%) of the 17 patients with an intact ventricular septum and 6 (43%) of the 14 patients with ventricular septal defect (VSD) underwent IE, whereas none of the patients with double outlet right ventricle or aortic arch obstruction (n = 4) did. Patients who had cardiopulmonary bypass time (CPB) >173 min (P = 0.01), lowest temperature on CPB (T min) ≤30.4 °C (P = 0.04) and aortic cross-clamp time >86 min (P = 0.04) were more likely to be left intubated at the end of the procedure. There was no significant difference in patient's chronological age, gestational age, post-conceptual age, weight, coronary anatomy or prevalence of VSD between those who did and did not undergo IE. There was a median increase in intensive care unit (ICU) length of stay (LOS) by 1 day (33%, P = 0.03) and ICU costs by $12 338 (15%, P = 0.06) in non-IE patients. The OR turnover time (P = 0.09) and reintubation rate (P = 1) at 24 h post-extubation did not differ between those who did and did not have IE. There was no myocardial dysfunction evident on predismissal echocardiography in either group. CONCLUSIONS: In this cohort of infants, post repair for TGA, 56% were extubated immediately in the OR. Greater CPB and cross-clamp times and T min ≤ 30.4 ° C were associated with a lesser likelihood of IE. IE was associated with shorter ICU length of stay.
AB - OBJECTIVES: We sought to identify preoperative, intraoperative and anatomical factors associated with immediate extubation (IE) after arterial switch operation for d-transposition of great arteries (dTGA). METHODS: This was a single-centre retrospective study performed from 1 January 2010 to 30 June 2015. IE was defined as successful extubation in the operating room (OR). Univariate/bivariate regression of preoperative, intraoperative and anatomical variables was used to determine associations with IE. RESULTS: Of 32 patients in the dTGA spectrum (age at operation 6 days), 18 (56%) underwent IE. Twelve (71%) of the 17 patients with an intact ventricular septum and 6 (43%) of the 14 patients with ventricular septal defect (VSD) underwent IE, whereas none of the patients with double outlet right ventricle or aortic arch obstruction (n = 4) did. Patients who had cardiopulmonary bypass time (CPB) >173 min (P = 0.01), lowest temperature on CPB (T min) ≤30.4 °C (P = 0.04) and aortic cross-clamp time >86 min (P = 0.04) were more likely to be left intubated at the end of the procedure. There was no significant difference in patient's chronological age, gestational age, post-conceptual age, weight, coronary anatomy or prevalence of VSD between those who did and did not undergo IE. There was a median increase in intensive care unit (ICU) length of stay (LOS) by 1 day (33%, P = 0.03) and ICU costs by $12 338 (15%, P = 0.06) in non-IE patients. The OR turnover time (P = 0.09) and reintubation rate (P = 1) at 24 h post-extubation did not differ between those who did and did not have IE. There was no myocardial dysfunction evident on predismissal echocardiography in either group. CONCLUSIONS: In this cohort of infants, post repair for TGA, 56% were extubated immediately in the OR. Greater CPB and cross-clamp times and T min ≤ 30.4 ° C were associated with a lesser likelihood of IE. IE was associated with shorter ICU length of stay.
KW - Congenital heart disease
KW - Immediate extubation
KW - Neonatal cardiac surgery
KW - Paediatric cardiology
KW - Transposition of great arteries
UR - http://www.scopus.com/inward/record.url?scp=85017395072&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85017395072&partnerID=8YFLogxK
U2 - 10.1093/ejcts/ezw424
DO - 10.1093/ejcts/ezw424
M3 - Article
C2 - 28199509
AN - SCOPUS:85017395072
SN - 1010-7940
VL - 51
SP - 728
EP - 734
JO - European Journal of Cardio-thoracic Surgery
JF - European Journal of Cardio-thoracic Surgery
IS - 4
M1 - ezw371
ER -