Reconstruction of aortal arch in patients with transposition of the main arteries: results of a one-stage correction

Keywords: transposition of the main arteries; obstruction of aortal arch; one-stage correction.

Abstract

Objective. To analyze immediate and late results of a one-stage surgical treatment of the main arteries transposition in conjunction with obstruction on the level of aortal arch.

Materials and metods. For the period 2010 - 2019 yrs in Amosov National Institute of Cardiovascular Surgery and Scientific-Practical Medical Centre of Pediatric Cardiology and Cardio-Surgery in 52 newborn babies a one-stage correction of the main arteries transposition with obstruction on the level of aortal arch was conducted. In the investigation were included only the patients with a two-ventricle physiology and further two-ventricle correction. There were 35 (67.3%) boys and 17 (32.7%) girls. Average age of the patients was (0.6 ± 0.3) mo, average body mass - (3.6 ± 0.8) kg. The main method of diagnosis in determination of the failure and estimation of immediate and late results was echocardiographic examination. In 24 (46.2%) of the patients while doing reconstruction of the aortal arch a selective antegrade cerebral perfusion was conducted.

Results. Hospital mortality have constituted 3.8% (n=2). Duration of artificial blood circulation have constituted (194.3 ± 73.1) min, aortal clamping - (108.5 ± 35.6) min, selective cerebral perfusion - (19.6 ± 7.2) min. In early postoperative period 6 (11.5%) patients have been with desintegrated sternum. Average duration of observation have constituted (3.7 ± 2.8) yr (from 1 no to 9.yrs). In late period one child died. In 5 (9.6%) patients in postoperative period restenosis in aortal arch have developed, who was successfully curated endovascularly, using balloon dilatation in 3 patients, In two secondary plasty of aortal arch was done surgically. Tracheal or the main bronchi compression, neurologic complications were not observed in remote period.

Conclusion. One-stage correction of the main arteries transposition together with the aortal arch hypoplasia - an effective and secure method of treatment of a newborn children with good immediate and late results. The investigation conducted gives a background to conclude, that this surgical strategy constitutes the affordable alternative to two-staged surgical treatment of this complex pathology.

Author Biographies

Ya. P. Truba, Amosov National Institute of Cardiovascular Surgery, Kyiv

Truba Yaroslav P. - MD, DSci(Med),
Head of Department of Congenital Heart Disease
Amosov National Institute of Cardiovascular Surgery, Kyiv;
03038, Ukraine, Kyiv, 6, N. Amosov str
+380 44 275-64-00
truba-mena@rambler.ru
orcid.org/0000-0001-5214-408X

M. P. Radchenko, Scientific-Practical Medical Centre of Pediatric Cardiology and Cardio-Surgery, Kyiv

Radchenko Maryanna P. - MD, Endovascular surgeon,
Department of X-ray and endovascular surgery,
Center For Pediatric Cardiology and Cardiac Surgery, Kyiv
Kyiv, st. Chornovola 28/1
(044) 238-78-07
mariannetkarad@gmail.com
orcid.org/0000-0002-7136-8764

I. V. Dzyurii, Amosov National Institute of Cardiovascular Surgery, Kyiv

Dzyurii Ivan V. - MD, Cardiac surgeon,
Department of Congenital Heart Disease
Amosov National Institute of Cardiovascular Surgery, Kyiv
03038, Ukraine, Kyiv, 6, N. Amosov str
+380 44 275-64-00
ivandzyurii@gmail.com.
orcid.org/0000-0002-1073-7060

O. S. Golovenko, Amosov National Institute of Cardiovascular Surgery, Kyiv

Golovenko Olexandr S. - MD, DSc (Med),
Head Scientific Researcher of Department of Congenital Heart Disease
Amosov National Institute of Cardiovascular Surgery, Kyiv
03038, Ukraine, Kyiv, 6, N. Amosov str
+380 44 275-64-00
dr.golovenko@gmail.com
orcid.org/0000-0001-6002-3325

V. V. Lazoryshynets, Amosov National Institute of Cardiovascular Surgery, Kyiv

Lazoryshynets Vasyl V. - MD, PhD (Med), Professor
Director of Amosov National Institute of Cardiovascular Surgery, Kyiv,
03038, Ukraine, Kyiv, 6, N. Amosov str
+380 44 275-64-00
lazorch@ukr.net
orcid.org/0000-0002-1748-561X

References

Fricke TA, Konstantinov IE. Arterial switch operation: operativ eapproach and outcomes. Ann Thorac Surg. 2018;107(1):302-10. doi: 10.1016/j.athoracsur.2018.06.002.

Fricke TA, Donaldson S, Schneider JR, Menahem S, Brizard CP, Konstantinov IE. Outcomes of the arterial switch operation in patients with aortic arch obstruction. J Thorac Cardiovasc Surg. 2019;159(2):592-99 doi: 10.1016/j.jtcvs.2019.07.103.

Pigott JD, Chin AJ, Weinberg PM, Wagner HR, Norwood WI. Transposition of the great arteries with aortic arch obstruction. Anatomical review and report of surgical management. J Thorac Cardiovasc Surg. 1987;94(1):82-6. PMID: 3600012.

Kwang Ho Choi, Si Chan Sung, Hyungtae Kim, Hyung Doo Lee, Gil Ho Ban, Geena Kim, et al. Transposition Complex with Aortic Arch Obstruction: Outcomes of One-Stage Repair Over 10 Years. Pediatr Cardiol 2016 Jan;37(1):160-6. doi: 10.1007/s00246-015-1258-6.

Huber C, Mimic B, Oswal N, Sullivan I, Kostolny M, Elliott M, et al. Outcomes and re-interventions after one-stage repair of transposition of great arteries and aortic arch obstruction. Eur J Cardiothorac Surg. 2011;39(2):213-20. doi: 10.1016/j.ejcts.2010.05.009.

Pocar M, Villa E, Degandt A, Mauriat Ph, Pouard Ph, Vouhé PR. Long-Term Results After Primary One-Stage Repair of Transposition of the Great Arteries and Aortic Arch Obstruction. J Am Coll Cardiol. 2005;46(7):1331-8. doi: 10.1016/j.jacc.2005.06.063.

Gupta B, Dodge-Khatami A, Tucker J, Taylor MB, Maposa D, Urencio M, et al. Antegrade cerebral perfusion at 25 °C for arch reconstruction in newborns and children preserves perioperative cerebral oxygenation and serum creatinine Transl Pediatr. 2016;5(3):114-24. doi: 10.21037/tp.2016.06.03.

Heinisch PP, Banz Y, Langhammer B, Stocker E, Erdoes G, Hutter D, et al. Histological analysis of failed submucosa patches in congenital cardiac surgery. Asian Cardiovasc Thorac Ann. 2019;27(6):459-63. doi: 10.1177/0218492319858557.

Published
2020-07-24
How to Cite
Truba, Y. P., Radchenko, M. P., Dzyurii, I. V., Golovenko, O. S., & Lazoryshynets, V. V. (2020). Reconstruction of aortal arch in patients with transposition of the main arteries: results of a one-stage correction. Klinicheskaia Khirurgiia, 87(5-6), 41-45. https://doi.org/10.26779/2522-1396.2020.5-6.41
Section
General Problems of Surgery