Moderate Versus Deep Hypothermia for Arterial Switch Operation

Abstract

Background: We evaluated the impact of moderate versus deep intraoperative hypothermia on postoperative morbidity in patients receiving a standard arterial switch operation (ASO). Methods: 71 newborns underwent ASO from 9/98 onwards. Patients were operated using moderate hypothermia (M, 24 °C to 30 °C, n = 21) or deep hypothermia (D, 16 - 22 °C, n = 50). Mean patient age was 9.5 (M) versus 10 (D) days, body weight 3.6 ± 0.7 (M) versus 3.8 ± 0.9 kg (D), p = n. s. Coronary anatomy was complex in 9.5 % (M) versus 16 % (D) of patients; additional VSD was present in 23.8 (M) versus 38 % (D) of the patients, respectively. Mean follow-up is 2.3 ± 1.6 years. Results: Intraoperative rectal temperature was 25 ± 2 °C (M) and 19 ± 2 °C (D). Cross-clamping time was 95 ± 24 (M) versus 108 ± 31 min (D), p = n. s. Conventional ultrafiltration was performed at 114 ± 46 (M) versus 129 ± 69 ml/kg (D), p = n. s. One patient (D) with complex anatomy suffered myocardial ischemia required ECMO support and died. In-hospital mortality was 1.4 %. All other patients were safely weaned from extracorporeal circulation with moderate inotropic support. Secondary chest closure was performed in 33 % (M) versus 54 % (D) of the patients. Patients were extubated after 7.4 (M) versus 6 (D) days. There was no renal failure and no other serious complications. Conclusions: ASO can be safely performed using moderate hypothermia, even with complex anatomy, leading to comparatively good results compared to a conventional approach.

Arterial switch operation - transposition of the great arteries - moderate hypothermia

References

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