Nida ÇELİK, Halil TÜRKOĞLU, Abdullah Arif YILMAZ, Türkay SARITAŞ, Ulaş KARADAŞ

Does late primary arterial switch operation with extracorporeal membrane oxygenator support change the surgical approach in simple transposition of the great arteries?

Günümüzde ventriküler septumu intakt, üç haftadan küçük basit büyük arter transpoziyonu olan hastalarda standart cerrahi tedavi primer arteriyel switch ameliyatı iken, üç haftadan büyüklerde bu tür bir standart yaklaşım yoktur ve cerrahi işlemler merkezler arasında değişiklik gösterebilmektedir. Üç haftadan sonra sol ventrikülün ilerleyici involüsyonu nedeniyle, arteriyel switch ameliyatı sonrası düşük kalp debisi ve sol ventrikül yetmezliği de gelişebilir. Bu nedenle, Senning veya Mustard işlemi veya iki aşamalı arteriyel switch ameliyatı, bu hasta popülasyonunda alternatif cerrahi tedavi yöntemleridir. Bununla birlikte, bu işlemlerin kısa ve uzun dönemde muhtemel komplikasyonları nedeniyle, üç haftadan büyük olan hastalarda ekstrakorporeal membran oksijenatörü desteği altında primer arteriyel switch ameliyatına karşı ilgi giderek artmaktadır. Bu yazıda, ekstrakorporeal membran oksijenatörü desteği altında primer arteriyel switch ameliyatı yapılan 110 günlük ve 60 günlük iki olgu sunuldu. Kısa dönemde ekstrakorporeal membran oksijenatörü desteği ile yapılan arteriyel switch ameliyatının, diğer seçeneklere kıyasla, daha etkili bir seçenek olabileceği düşünülmektedir.

Basit büyük arter transpozisyonunda ekstrakorporeal membran oksijenatör destekli geç primer arteriyel switch ameliyatı cerrahi yaklaşımı değiştirir mi?

Currently, arterial switch operation appears as a standard surgical management for patients under three weeks of age with transposition of the great arteries with an intact ventricular septum, while, beyond three weeks of age, there is no such standard approach and surgical procedures may vary among the health care centers. Low cardiac output and left ventricle failure may also develop after three weeks due to the progressive involution of left ventricle after arterial switch operation. Therefore, the Senning or Mustard procedure, or two-stage repair arterial switch operation are optional surgical management modalities in this patient population. However, due to the potential complications of these procedures in the short- and long-term, there has been an increased interest in performing primary arterial switch operation with extracorporeal membrane oxygenator support in patients older than three weeks of age. This report presents two cases in whom primary arterial switch operation with extracorporeal membrane oxygenator support was performed at the age of 110 days and 60 days, respectively. Primary arterial switch operation with extracorporeal membrane oxygenator support appears to be a more effective option in the short-term than alternative surgical management modalities.

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