The Impact of Length of Post-Operative Ventilator Support on Outcome of the Arterial Switch Operation Report from a Single Institute

Background: The arterial switch operation (ASO) is the gold-standard surgical procedure for transposition of the great arteries (TGA) in newborns and small infants. The goal of this current study is to describe the postoperative respiratory care and the current outcomes of the patients that underwent ASO for TGA at our institute. Method: We retrospectively enrolled 28 patients (23 males and 5 females) with TGA, who underwent ASO in this institution between January 2006 and December 2008, and analyzed some parameters. The outcome measurements were length of ventilator support, re-intervention rate and survival during hospitalization. Results: Ages and body weights at ASO were 17.2 32.3 days (median, 5 days; range, 0-158 days) and 3.1 0.6 kg (median, 3; 1.3-5 kg), respectively. Partial cardio-pulmonary bypass (CPB) time was 231.8 56.9 (163.0-377.0) minutes, total CPB time 192.8 56.1 (134.0-308.0) minutes and aortic cross-clamp time 125.3 36.0 (62.0-194.0) minutes. In this cohort, the mean ventilator duration was 12.8 14.3 days (median, 7; range, 2-61) for all patients and 11.2 11.3 days (median, 7; range, 3-50) for survivors. Yearly report showed that median ventilator duration was 17.5 days and survival was 73% in 2006, 8.6 days of ventilation and 100% survival in 2007, and 6.4 days of ventilation and 91% survival in 2008. Multivariate analysis showed patients with aortic coarctation had longer ventilation durations, possibly related to increased lung fluid caused by cardiopulmolnary bypass and increased left ventricular afterload. A higher re-intervention rate was found in patients with ventilation support > 14 days (p < 0.05). Conclusion: Ventilation duration shortened and survival rate increased gradually from 2006 to 2008. Patients with aortic coartation had longer ventilator support. Cardiorespiratory investigation or intervention was indicated in patients who required ventilation support more than 14 days postoperatively.