Valoración pronóstica del switch arterial en la transposición de grandes arterias

• Autores: J.A. García-Hernández, Cristina Montero Valladares, Adoración I. Martínez López, Mauro Gil-Fournier Carazo, JM Praena-Fernández, J. Cano-Franco, M. Loscertales Abril
• Localización: Anales de Pediatría: Publicación Oficial de la Asociación Española de Pediatría ( AEP ), ISSN-e 1696-4608, ISSN 1695-4033, Vol. 74, Nº. 3, 2011, págs. 174-181
• Idioma: español
• Títulos paralelos:
  • Prognostic evaluation of arterial switch in the transposition of great arteries
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• Resumen

  • Introduction and objectives The arterial switch is the procedure of choice for transposition of great arteries, with or without ventricular septal defect. The aim of this study was to identify risk factors for hospital mortality.

    Methods The study included 121 children between January 1994 and June 2008. Of these, 80 (66%) were diagnosed with intact ventricular septum, and 41 (34%) with ventricular septal defect. Variables were collected pre-operatively, during surgery, and postoperatively.

    Results The mean age was 11 [8 to 16] days and a mean weight of 3.5 [3.0 to 3.7] kg. A ventricular septal defect was closed in 11 children (9.1%). Atotal of 81.8% had a normal coronary pattern. There was delayed closure of the chest in 38 patients (31.4%). The hospital mortality was 11.6%, decreasing over the past 5 years to 2.1%. The weight, abnormal coronary pattern, time of cardiopulmonary bypass, mean arterial pressure at admission, pulmonary dead space, and delayed closure of the chest, were risk factors of mortality. The model that best predicts the death, consists of the mean arterial pressure at admission, and delayed closure of the chest.

    Conclusions The reduction in extracorporeal circulation time and the use of delayed closure of the chest, have helped to reduce mortality. The abnormal coronary pattern remains a risk factor for mortality. In children with delayed closure of the chest, a mean arterial pressure at admission = 47.5 mmHg is a goal to achieve.