A Study Of Surgical Treatment Strategies For Complete Transposition Of The Great Arteries With Intact Ventricular Septum In Overaged Patients

Dextro-transposition of great arteries with intact ventricular septum(dTGA-IVS)is usually recommended for the treatment with arterial switch operation(ASO)in the neonatal period.However,due to various reasons,in developed and developing countries,there are still a certain number of children who are above the optimal age for surgery at the time of consultation.Surgical treatment strategies for such children have undergone constant changes since 1950s.And it is also a process of deepening understanding of the disease.From the earliest palliative treatment to physiological correction surgery,to anatomical correction surgery,until today,surgical treatment of such children is still a complicated surgical problem,and there are many controversies.This article summarizes the history of the development of surgical treatment strategies for children with dTGA-IVS and the latest clinical experience sharing for such children through literatures review.Two-stage Arterial Switch For D-Transposition of The Great Vessels with Intact Ventricular SeptumAbstractObject:This study investigates the two-stage arterial switch operation(ASO)performed to treat TGA-IVS in late referral patients.Methods:From February 2007 to August 2018,we retrospectively analysed patients with dTGA-IVS or dTGA with restricted VSD who underwent a two-stage ASO in our institution.A total of 41 patients were included,21 patients(51.2%)underwent long-term two-stage ASO and 20 patients(48.8%)underwent rapid two-stage ASO.Results:The long-term two-stage group had older age at ASO(3.5 versus 25 months,p<0.001).The ICU time,mechanical ventilation time,and hospital stay were more satisfactory in the long-term group than rapid group(P=0.004,P=0.004,P=0.007 respectively).There was no inhospital mortality in long-term group and the postoperative course was easier in the long-term group than in the rapid group.However,the significant neoaortic regurgitation was lower in the rapid group which also had a better LVEF.Cox regression analysis suggests that patients with long-term LV retraining had greater risk of AV regurgitation compared to patients in the rapid group(HR:0.11,95%CI:0.01-1.22,P=0.072).There may have been a marginal difference in K-M curve of AV regurgitation between the two groups because of the small samples size(p=0.084).Conclusion:Comparing these two group,there was a better early-term outcome in the long-term group.However,there also a high risk of neoaortic regurgitation and myocardial dysfunction.In the long run,ASO should be performed as soon as possible if left ventricular function allows.Objective This study aims to explore the mechanism of left ventricular degeneration in children with dextro-transposition of great arteries with intact ventricular septum(dTGA-IVS).By a comparative study of two treatment strategies for late presenters of dTGA-IVS to explore the effect of preoperative echocardiography on prediction of the left ventricle degradation.Methods A retrospective analysis of 76 children with dTGA-IVS whose age>28 days at the first operation was divided into two-stage aortic switch operation(ASO)group(n=38)and one-stage ASO group(n=38).Based on the baseline data of the two groups of patients and preoperational echocardiography before the first surgical treatment:left ventricular end diastolic diameter(LVEDD),with or without patent ductus arteriosus(PDA),effective diameter of atrial septal defect(ASD),and ventricular septal position Statistical analysis was performed on the comparison of two groups.Results A total of 76 children were enrolled in this study,including 48 males(63.2%)and 28 females(36.8%),with a median age of 3.9 months(31 days to 7 years).Their weight was 6.49±3.43 kg.The intraoperative measurement of left ventricular systolic pressure/right ventricular systolic pressure(P=0.002)and the effective shunt diameter of atrial septal defect(P=0.001)had significant differences between the groups.The age,weight,and effective shunt diameter of the atrial septal defect at surgical treatment were significantly negatively correlated with left ventricular systolic pressure/right ventricular systolic pressure.Conclusion For children with dTGA-IVS who delayed the surgical treatment,a preoperative evaluation is important for the selection of surgical strategies.Age,weight and preoperative echocardiographic measurement of the effective shunt diameter of atrial septal defect are significantly related to the actual left ventricular functional status of children with dTGA-IVS.