Early outcome for the primary arterial switch operation beyond the age of 3 weeks.

The arterial switch operation (ASO) for neonates is the standard management for transposition of the great arteries (TGA) with an intact ventricular septum (IVS). Patients presenting for late ASO are at risk due to the possibility of left ventricle (LV) involution. This study aimed to assess the early postoperative course and outcome for children with TGA/IVS and still conditioned LV presenting for late primary ASO. A retrospective study of all TGA/IVS patients who underwent a primary ASO between March 2002 and March 2008 was conducted. The cases were divided into two groups. Group A included all the cases of early ASO repaired before the age of 3 weeks, whereas group B included all the preslected cases of late ASO repaired after the age of 3 weeks. The demographics, intensive care unit (ICU) parameters, complications, and short-term outcomes of the two groups were compared. The study enrolled of 91 patients: 64 patients (70%) in group A and 27 patients (30%) in group B. The mean age was 11 +/- 4 days in group A and 37 +/- 17 days in group B (P < 0.001). The two groups showed no significant statistical differences in ICU parameters, complications, or mortality. For patients with TGA/IVS, ASO still can be tolerated beyond the first month of life in selected cases. Provided the LV still is conditioned, age should not be a limitation for ASO.

Early outcome of tetralogy of Fallot repair in the current era of management.

BACKGROUND: Traditional use of trans-annular patch (TAP) to release right ventricular outflow tract (RVOT) obstruction during tetralogy of Fallot (TOF) repair may lead to a harmful pulmonary regurgitation. Different approaches have been used to release RVOT obstruction and spare the pulmonary valve (PV) function. In this study, we aim to evaluate the post-operative course of patients who had TOF repair in the current era that emphasizes on protective strategy of releasing RVOT obstruction and preserving PV function. METHODS: A retrospective study of all TOF cases repaired in our institute between March 2002 and December 2007 was conducted. Cases were classified into two groups; group I included patients that had a TAP, while group II included cases that had simple TOF repair without TAP. Group I was subdivided into two groups, group (A) which include patients who had TAP without a valve. Group (B) includes those who had TAP with a monocuspid valve (Contegra). We compared post-operative care and outcome of all groups. RESULTS: Eighty-three patients fulfilled the study criteria. There were 64 cases (77%) in group I, and 19 cases (23%) in group II. All children tolerated surgical repair and did well. We observed no statistically significant difference in the post-operative ICU care, complications rates and morbidity between all groups. There was no surgical mortality in all groups. CONCLUSION: Children undergoing TOF repair had excellent short-term outcome with the current protective strategy aiming to spare valvular function, and conserving myocardial function. Applying a monocuspid patch technique did not show clear short-term benefits. Long term follow up is needed to evaluate future difference in different techniques.