ISSN : 1301-5680
e-ISSN : 2149-8156
TURKISH JOURNAL OF
THORACIC AND
CARDIOVASCULAR SURGERY
Turkish Journal of Thoracic and Cardiovascular Surgery     
Is arterial switch operation possible with neonatology-focused intensive care unit modality
Onur Doyurgan1, Fatih Özdemir1, Osman Akdeniz2, Ahmet Kuddusi İrdem1, Nilüfer Matur Okur3, Fikret Salık4, Bedri Aldudak2
1Department of Pediatric Cardiovascular Surgery, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
2Department of Pediatric Cardiology, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
3Department of Neonatology, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
4Department of Anesthesiology and Reanimation, Health Sciences University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
DOI : 10.5606/tgkdc.dergisi.2021.20309
Background: In this study, we aimed to examine the feasibility of arterial switch operation and its perioperative management with neonatology-focused intensive care modality in a region of Turkey where the birth rate and the number of asylum seekers who had to leave their country due to regional conflicts are high.

Methods: Between December 2017 and June 2020, a total of 57 patients (48 males, 9 females; median age: 12.2 days; range, 2 to 50 days) who were diagnosed with transposition of the great arteries in our clinic and underwent arterial switch operation were retrospectively analyzed. All patients were followed by the neonatologist in the neonatal intensive care unit during the preoperative and postoperative period.

Results: Thirty-eight (66.7%) patients had intact ventricular septum, 16 (28.1%) had ventricular septal defect, two (3.5%) had coarctation of the aorta, and one (1.7%) had Taussig-Bing anomaly. Coronary artery anomaly was present in 14 (24.5%) patients. The most common complications in the intensive care unit were renal failure requiring peritoneal dialysis in seven (12.3%) patients, supraventricular tachyarrhythmia in six (10.5%) patients, and eight (14%) patients left their chests open. The median length of stay in intensive care unit was 13.8 (range, 9 to 25) days and the median length of hospital stay was 24.5 (range, 16 to 47) days. The overall mortality rate for all patients was 12.3% (n=7). The median follow-up was 8.2 months. A pulmonary valve peak Doppler gradient of ≥36 mmHg was detected in five patients (8.7%) who were followed, and these patients were monitored by providing medical treatment. None of the patients needed reoperation or reintervention.

Conclusion: We believe that arterial switch operation, one of the complex neonatal cardiac surgery, can be performed with an acceptable mortality and morbidity rate with the use of neonatology-focused intensive care modality, which is supported by pediatric cardiology and pediatric cardiac surgery.

Keywords : Arterial switch operation, COVID-19, intensive care, refugee, pandemic
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