Ardawan J. Rastan, Thomas Walther, Nidal Al-Alam, Ingo Daehnert, Wilfried Bellinghausen, Joerg Hambsch, Friedrich W. Mohr, Jan Janousek, Martin Kostelka; Heart Center Leipzig, Leipzig, Germany
Objective: We evaluated the impact of moderate versus deep perioperative hypothermia on postoperative morbidity in patients receiving the arterial switch operation (ASO).Methods: One hundred infants received the ASO from 9/98 to 4/06. Patients were operated using moderate (M, >22°C, n=51) or deep hypothermia (D, =22°C, n=49), respectively. Complex TGA morphology was present in 33 patients (M:27.4%, D:38.8%, n.s.). Coronary anatomy was complex in 20 patients each. Median age were 10 (M) vs 9 (D) days, body weight was 3.5±0.7 (M) vs 3.6±0.9 kg (D), p=n.s. Mean follow-up was 3.3±2.3 years.
Results: Perioperative rectal temperature was 24.3±2.1°C (M) and 19.0±1.7°C (D), p<0.001. Conventional perioperative filtration was performed with mean 150±63 (M) versus 117±66 ml/kg (D), p=0.02. Intraoperative blood transfusion (M:230±47, D:251±112ml, p=0.01) and postoperative lactate level (M:3.2±1.3, D:3.8±2.4 mmol/l, p=0,02) were lower under moderate hypothermia. One patient (D) with complex anatomy suffered myocardial ischemia, required ECMO support and died. In-hospital mortality was 1.0%. All other patients were safely weaned from extracorporeal circulation with moderate inotropic support using dopamine (M:1.0 vs. D:1.1 µg/kg/min, n.s.) and dobutamine (M:1.6, D:2.2µg/kg/min, p=0.048). Secondary chest closure was performed in 41% (M) versus 59% (D) of the patients (p=0.04). Patients were extubated after 2.7 (M) versus 3.9 (D) days. None of the patients suffered postoperative renal failure nor other serious complications. ICU stay (M:8.4±4.7, D:12.0±13.8d, p=0.03) and hospital stay (M:20.7±15.5, D:12.8±6.8d, p=0.001) was shorter after moderate hypothermia. Six-year freedom from reoperation is 96.9% for simple and 83.3% for complex TGA with RVOT reconstruction in 7/9 reoperations.
Conclusion: The ASO can be safely performed using moderate hypothermia, even in complex anatomy. The moderate hypothermic strategy is associated with significantly lower morbidity, faster respiratory recovery, a higher primary chest closure rate and less resource utilization.
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