Five-year experience with immediate extubation after arterial switch operations for transposition of great arteries

• Published in: European journal of cardio-thoracic surgery 2017-04, Vol.51 (4), p.728-734
• Main Authors: Varghese, Joby, Kutty, Shelby, Bisselou Moukagna, Karl Stessy, Craft, Mary, Abdullah, Ibrahim, Hammel, James M.
• Format: Article
• Language: English
• Subjects: Airway Extubation - methods; Anesthesia, General - methods; Arterial Switch Operation - methods; Critical Care; Heart Septal Defects, Ventricular - pathology; Humans; Infant, Newborn; Length of Stay - statistics & numerical data; Postoperative Care - methods; Postoperative Period; Retrospective Studies; Transposition of Great Vessels - pathology; Transposition of Great Vessels - surgery; Treatment Outcome
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezw424

Abstract OBJECTIVES: We sought to identify preoperative, intraoperative and anatomical factors associated with immediate extubation (IE) after arterial switch operation for d-transposition of great arteries (dTGA). METHODS: This was a single-centre retrospective study performed from 1 January 2010 to 30 June 2015. IE was defined as successful extubation in the operating room (OR). Univariate/bivariate regression of preoperative, intraoperative and anatomical variables was used to determine associations with IE. RESULTS: Of 32 patients in the dTGA spectrum (age at operation 6 days), 18 (56%) underwent IE. Twelve (71%) of the 17 patients with an intact ventricular septum and 6 (43%) of the 14 patients with ventricular septal defect (VSD) underwent IE, whereas none of the patients with double outlet right ventricle or aortic arch obstruction (n = 4) did. Patients who had cardiopulmonary bypass time (CPB) >173 min (P = 0.01), lowest temperature on CPB (T min) ≤ 30.4°C (P = 0.04) and aortic cross-clamp time >86 min (P = 0.04) were more likely to be left intubated at the end of the procedure. There was no significant difference in patient’s chronological age, gestational age, post-conceptual age, weight, coronary anatomy or prevalence of VSD between those who did and did not undergo IE. There was a median increase in intensive care unit (ICU) length of stay (LOS) by 1 day (33%, P = 0.03) and ICU costs by $12 338 (15%, P = 0.06) in non-IE patients. The OR turnover time (P = 0.09) and reintubation rate (P = 1) at 24 h post-extubation did not differ between those who did and did not have IE. There was no myocardial dysfunction evident on predismissal echocardiography in either group. CONCLUSIONS: In this cohort of infants, post repair for TGA, 56% were extubated immediately in the OR. Greater CPB and cross-clamp times and T min ≤ 30.4°C were associated with a lesser likelihood of IE. IE was associated with shorter ICU length of stay.