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<p>We examined the current practice, factors associated with delay, and impact of timing of arterial switch operation (ASO) on outcomes of d-transposition of great arteries (d-TGA) with intact ventricular septum (IVS). Neonates with d-TGA + IVS undergoing ASO were identified from the Pediatric Health Informational System database. Factors associated with delayed repair, practice trends, and outcomes related to surgical timing were analyzed. A cut-point analysis was performed to determine if an age threshold predicted in-hospital death or post-op ECMO. A total of 3523 patients were included. The distribution by age was: 0–3 d: 24%, 4–7 d: 51%, 8–14 d: 20%, 15–30 d: 6%; median: 5 d(IQR 4–8). A cut-off age of 7&#xa0;days was identified for the composite outcome (death/ECMO), with an odds ratio of 1.79 (95%CI: 1.13–2.82), <i>p</i> = 0.013, after adjusting for prematurity and other confounders. Predictors of delay beyond seven days included [OR(95% CI)] non-birth admissions:6.31(4.37–9.12), &lt; 2&#xa0;kg-birthweight: 3.21(1.69–6.09), pre-operative-stroke: 2.86(1.73–4.74), and balloon atrial septostomy: 2.25(1.81–2.79). Increasing center case volume was associated with earlier repair: 0.82(0.78–0.85), all <i>p</i> &lt; 0.05. A trend was observed in decreasing age at ASO in the latest study years: 2018–2024 median age (IQR): 5&#xa0;days (3–7) vs 2004–2017: 6&#xa0;days (4–8), <i>p</i> &lt; 0.001. In this large multicenter cohort comprised exclusively of d-TGA + IVS neonates; we found that ASO performed after the age of seven days resulted in worse in-hospital outcomes. Factors associated with surgical delay included non-birth admission, low-birthweight, pre-operative stroke, and balloon atrial septostomy. A trend toward very early repair within the first five days of life has emerged in the past decade.</p>

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Timing of Arterial Switch Operation in Dextro-Transposition of Great Arteries with Intact Septum: Factors Associated with Delay, Practice Variation, and Associated Outcomes

  • 期刊论文

  • 发表日期：

    2025年5月24日

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  • Muhammad Faateh,
  • Hosam F. Ahmed,
  • Muhammad Aanish Raees,
  • Md Monir Hossain,
  • David Lehenbauer,
  • James F. Cnota,
  • Jeffrey A. Alten,
  • David Morales,
  • Awais Ashfaq

摘要

We examined the current practice, factors associated with delay, and impact of timing of arterial switch operation (ASO) on outcomes of d-transposition of great arteries (d-TGA) with intact ventricular septum (IVS). Neonates with d-TGA + IVS undergoing ASO were identified from the Pediatric Health Informational System database. Factors associated with delayed repair, practice trends, and outcomes related to surgical timing were analyzed. A cut-point analysis was performed to determine if an age threshold predicted in-hospital death or post-op ECMO. A total of 3523 patients were included. The distribution by age was: 0–3 d: 24%, 4–7 d: 51%, 8–14 d: 20%, 15–30 d: 6%; median: 5 d(IQR 4–8). A cut-off age of 7 days was identified for the composite outcome (death/ECMO), with an odds ratio of 1.79 (95%CI: 1.13–2.82), p = 0.013, after adjusting for prematurity and other confounders. Predictors of delay beyond seven days included [OR(95% CI)] non-birth admissions:6.31(4.37–9.12), < 2 kg-birthweight: 3.21(1.69–6.09), pre-operative-stroke: 2.86(1.73–4.74), and balloon atrial septostomy: 2.25(1.81–2.79). Increasing center case volume was associated with earlier repair: 0.82(0.78–0.85), all p < 0.05. A trend was observed in decreasing age at ASO in the latest study years: 2018–2024 median age (IQR): 5 days (3–7) vs 2004–2017: 6 days (4–8), p < 0.001. In this large multicenter cohort comprised exclusively of d-TGA + IVS neonates; we found that ASO performed after the age of seven days resulted in worse in-hospital outcomes. Factors associated with surgical delay included non-birth admission, low-birthweight, pre-operative stroke, and balloon atrial septostomy. A trend toward very early repair within the first five days of life has emerged in the past decade.