Anesthetic management and outcome of complex late arterial-switch operations for patients with transposition of the great arteries and a systemic right ventricle.

OBJECTIVE

For patients with transposition of the great arteries and a systemic right ventricle, complex late arterial-switch operations (double switch, switch conversion, Senning-Rastelli) after the newborn period have been described recently to restore the morphologic left ventricle to the systemic circulation. The purpose of this study was to describe the anesthetic management and perioperative outcome of this group of patients and to compare them with a control group of patients who had primary arterial-switch operations in the neonatal period.

DESIGN

Retrospective database and medical record review with 3:1 control:case ratio.

SETTING

Tertiary care academic children's hospital.

PARTICIPANTS

Patients undergoing complex late-arterial switch operations after the newborn period.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN

RESULTS

Thirteen patients were identified in the complex late-switch group and 43 in neonatal arterial-switch group. There were no perioperative deaths, no new gross neurologic deficits, and all patients were discharged home in both groups. Anesthetic and bypass times were significantly longer in the late-switch group (745 v 558 minutes, p < 0.001, and 382 v 243 minutes, p < 0.001, respectively). Transfusion requirements were similar between the groups. The incidence of arrhythmia (92% v 9%, p < 0.001), use of pacing systems (69% v 9%, p < 0.001), cardioversion (15% v 0%, p = 0.05), and pharmacologic treatment of arrhythmias (69% v 0%, p < 0.01) intraoperatively were significantly higher in the complex late-switch group.

CONCLUSIONS

Patients presenting for complex late corrective operations for transposition of the great arteries require long and complex anesthetics. Despite these challenges, perioperative outcomes are excellent.