Onur DOYURGAN, Fatih ÖZDEMİR, Osman AKDENİZ, Ahmet Kuddusi İRDEM, Nilufer OKUR, Fikret SALIK, Bedri ALBUDAK

Is arterial switch operation possible with neonatology-focused intensive care unit modality

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.

Neonatoloji odaklı yoğun bakım modalitesi ile arteriyel switch ameliyatı yapılabilir mi?

nedeniyle ülkelerinden ayrılmak zorunda kalan sığınmacı sayısının yüksek olduğu bir bölgesinde, arteriyel switch ameliyatının ve neonatoloji odaklı yoğun bakım modalitesi ile perioperatif yönetiminin uygulanabilirliği incelendi. Çalışma planı: Aralık 2017 - Haziran 2020 tarihleri arasında büyük arter transpozisyonu tanısı konan ve arteriyel switch ameliyatı yapılan toplam 57 hasta (48 erkek, 9 kadın; medyan yaş: 12.2 gün, dağılım, 2-50 gün) retrospektif olarak incelendi. Tüm hastalar ameliyat öncesi ve ameliyat sonrası dönemde yenidoğan yoğun bakım ünitesinde neonatoloji uzmanı tarafından izlendi. Bulgular: Hastaların 38’inde (%66.7) intakt ventriküler septum, 16’sında (%28.1) ventriküler septal defekt, ikisinde (%3.5) aort koarktasyonu ve birinde (%1.7) Taussig-Bing anomalisi vardı. On dört hastada (%24.5) koroner arter anomalisi mevcuttu. Yoğun bakım ünitesinde en sık görülen komplikasyonlar yedi hastada (%12.3) periton diyalizi gerektiren böbrek yetmezliği, altı hastada (%10.5) supraventriküler taşiaritmi idi ve sekiz hastada (%14) göğüs açık olarak ameliyattan çıkıldı. Medyan yoğun bakım ünitesinde kalış süresi 13.8 gün (dağılım, 9-25) gün ve medyan hastanede kalış süresi 24.5 (dağılım, 16-47) gün idi. Tüm hastalar için genel mortalite oranı %12.3 (n=7) olarak bulundu. Medyan takip süresi 8.2 ay idi. Takip edilen hastaların beşinde (%8.7) pulmoner kapak peak Doppler gradiyenti ≥36 mmHg saptandı ve bu hastalar medikal tedavi verilerek izlendi. Hiçbir hastada yeniden ameliyat veya yeniden girişim gerekmedi. Sonuç: Arteriyel switch ameliyatı gibi yenidoğanın kompleks kalp ameliyatları sonrası yoğun bakım takibinin, çocuk kardiyolojisi ve çocuk kalp cerrahisinin de desteklediği neonatoloji odaklı yoğun bakım modalitesi ile kabul edilebilir bir mortalite ve morbidite oranı ile yapılabileceği kanaatindeyiz.

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