Abstract
Introduction. In the long-term period after the operation of arterial switching in patients with transposition of the
main arteries, there is a high risk of developing neurological complications, which is associated with the need for an
operation with the use of artificial circulation, systemic hypothermia, and perioperative risk factors.
Material and methods. For the study included 248 patients with a simple transposition of the main arteries to which
the arterial switching operation was performed.
Results. The incidence of neurologic complications in the long-term period was 52.8% (131 patients). The average
age of the patients at the time of diagnosis of the complication was 42.8±34.6 months (6 months – 12.5 years). As a
result of the completed phase of the study, the structure and frequency of development of neurological complications
in the long-term period after the operation of arterial switching were determined, the most significant predictors of
the development of neurological complications were identified: duration of artificial circulation (p=0.02), arterial
blood oxygen saturation (р=0.05), cases of arrhythmia in the postoperative period (p=0.045), presence of right ventricular
exit and / or pulmonary artery and / or its branches after surgery (p=0.031). The risk factor, which has the
greatest prognostic significance for the outcome (complication development), was the duration of the operation.
Conclusion. Based on the data obtained, the identified predictors determine the need for a comprehensive approach
to dynamic observation, correction of cardiac, surgical, anesthesia and perfusion tactics in the treatment of patients
with this pathology in order to minimize the risk of developing neurological complications in the long-term period
after the operation of arterial switching.
References
- Show P.J. The nevrological sequelae of cardiopulmonary
bypass: The Newcastle experience. Cardiac surgery and
the brain. London; 1993: 24–33. DOI: 10.1046/j.1444-2892.2001.00103.x
- Khalil A., Suff N., Thilaganathan B., Hurrell A., Cooper
D., Carvalho J.S. Brain abnormalities and neurodevelopmental
delay in congenital heart disease: systematic
review and meta-analysis. Ultrasound. Obstet. Gynecol.
2014; 43: 14–24. DOI: 10.1002/uog.12526
- Mulkey S.B., Swearingen C.J., Melguizo M.S., Rachel
N.R., Jacob A.R., Neal G. et al. Academic proficiency
in children after early congenital heart disease surgery.
Pediatr. Cardiol. 2014; 35: 344–52.
- Calderon J., Bonnet D., Pinabliaux C., Jambaqué I.,
Angeard N. Use of early remedial services in children
with transposition of the great arteries. J. Pediatr. 2013;
163: 1105–10. DOI: 10.1016/j.jacc.2014.06.1150
- Bellinger D.C., Wypij D., Rivkin M.J., DeMaso D.R.,
Robertson R.L. Jr, Dunbar-Masterson C. et al.
Adolescents with d-transposition of the great arteries
corrected with the arterial switch procedure.
Neuropsychological assessment and structural brain
imaging. Circulation. 2011; 124: 1361–9. DOI: 10.1161/CIRCULATIONAHA.111.026963
- Marino B.S., Lipkin P.H., Newburger J.W., Peacock G.,
Gerdes M., Gaynoret J.W. et al. Neurodevelopmental
outcomes in children with congenital heart disease:
evaluation and management: a scientific statement
from regarding the American Heart Association.
Circulation. 2012; 126: 1143-72. DOI: 10.1161/CIR.0b013e318265ee8a
- Müller J., Pringsheim M., Engelhardt A., Meixner J.,
Halle M., Oberhoffer R., Hess J., Hager A. Motor
training of sixty minutes once per week improves
motor ability in children with congenital heart
disease and retarded motor development: a pilot study.
Cardiol. Young. 2013; 23: 717–21. DOI: 10.1017/S1047951112001941
- Andropolous D.B., Easley R.B., Brady K., McKenzie
E.D., Heinle J.S., Dickerson H.A. et al. Changing
expectations for neurological outcomes after the neonatal
arterial switch operation. Ann. Thorac. Surg. 2012; 94:
1250–5. DOI: 10.1016/j.athoracsur.2012.04.050
- Schaefer C., von Rhein M., Knirsch W., Huber R.,
Natalucci G., Caflisch J. et al. Neurodevelopmental outcome,
psychological adjustment, and quality of life in
adolescents with congenital heart disease. Dev. Med.
Child. Neurol. 2013; 55: 1143–9. DOI: 10.1111/dmcn.12242
- Ruys T.P.E., van der Bosch A.E., Cuypers J.A.A.E.,
Witsenburg M., Helbing W.A., Bogers A.J. et al. Longterm
outcome and quality of life after arterial switch
operation: a prospective study with a historical comparison.
Congenit. Heart Dis. 2013; 8: 203–10. DOI: 10.1111/chd.12033
About the authors
- Inessa E. Nefedova, Cand. Med. Sc., Head of Department; orcid.org/0000-0002-9221-051X
-
Aleksey V. Vanichkin, Cand. Med. Sc., Neurologist; orcid.org/0000-0002-5362-6598
-
Irina Yu. Baryshnikova, Cand. Med. Sc., Researcher; orcid.org/0000-0001-8071-2531
-
Ol’ga Yu. Dariy, Radiologist; orcid.org/0000-0003-0140-8166
