Arterial Switch Operation in the First 2 Days of Life

Area of Science:

• Pediatric Cardiac Surgery
• Neonatal Cardiology
• Congenital Heart Disease Management

Background:

• Arterial switch operation (ASO) is the standard treatment for neonates with transposition of the great arteries (TGA).
• The safety and efficacy of ASO within the first 48 hours of life require further definition.
• Outcomes of very early ASO (≤48 hours) compared to repair on postnatal days 3-7 are evaluated.

Purpose of the Study:

• To compare the outcomes of very early ASO (≤48 hours) with conventional early ASO (days 3-7) in neonates with TGA.
• To assess the safety, morbidity, mortality, and length of hospital stay associated with different ASO timing.

Main Methods:

• Retrospective review of neonates undergoing ASO at a single tertiary congenital cardiac center (1992-2022).
• Comparison of outcomes between neonates repaired within ≤48 hours versus those repaired on days 3-7.
• Primary outcomes: mortality and reintervention. Secondary outcomes: postoperative morbidity and hospital length of stay.

Main Results:

• Among 633 neonates, 78 (12.3%) had ASO within ≤48 hours and 396 (62.5%) between days 3-7.
• Very early ASO (≤48 hours) showed similar low postoperative morbidity and no increase in mortality.
• Neonates repaired within ≤48 hours had a shorter hospital stay (7 vs 9 days, p=0.004), with comparable long-term reintervention rates after propensity matching.

Conclusions:

• ASO within the first 48 hours is safe and effective in appropriately selected neonates with TGA.
• Outcomes are comparable to repair on postnatal days 3-7, with a potential trend toward shorter hospitalization.
• Very early ASO is a viable alternative in experienced centers.