Impact of Persistent Pulmonary Hypertension of the Newborn in Neonates with Dextro-transposition of the Great Arteries

• Published in: Journal of cardiothoracic and vascular anesthesia
• Main Authors: Modestini, Marco, Massari, Dario, Huisman, Susanne, Struys, Michel M.R.F., Roofthooft, Marcus T.R., Vos, Jaap Jan
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 26-09-2024
• Subjects: congenital heart disease; dextro-transposition of the great arteries; newborns; pulmonary hypertension of the newborn; dextro-transposition of the great arteries; congenital heart disease; pulmonary hypertension of the newborn; newborns
• ISSN: 1053-0770; 1532-8422; 1532-8422
• DOI: 10.1053/j.jvca.2024.09.141

•We assessed outcomes in newborns with transposition of the great arteries.•Persistent pulmonary hypertension of the newborn did not affect mortality/morbidity.•Intraoperative cerebral oxygen desaturation did not affect mortality/morbidity.•Longer cardiopulmonary bypass duration was associated with length of ICU stay.•A lower weight at birth was associated with preoperative mortality.
This study aimed to assess the impact of persistent pulmonary hypertension of the newborn (PPHN) on perioperative morbidity and mortality in patients with dextro-transposition of the great arteries. Secondarily, we evaluated the association between postoperative outcomes and intraoperative variables including the duration of cardiopulmonary bypass, cerebral oxygen desaturation, and hypotension.
Retrospective observational study.
Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands, over a 14-year period from January 2005 to December 2018.
The study included 99 consecutive patients with simple dextro-transposition of the great arteries with or without a ventricular septal defect.
All patients received preoperative management including intravenous prostaglandin E1 and, when necessary, a balloon atrial septostomy. Patients were then scheduled for an arterial switch operation.
Patients were divided into a PPHN and a non-PPHN group. The outcomes assessed included mortality (overall, preoperative, 30-day postoperative and late mortality) and postoperative morbidity (length of ventilatory support, intensive care unit and hospital stay, delayed sternal closure and resternotomy). PPHN was present in 31% of patients. Overall mortality was 8.1%, with no difference between PPHN and non-PPHN patients (9.7 v 7.4%, p = 0.70). PPHN had no effect on morbidity outcomes. A lower weight at birth was associated with preoperative mortality. Duration of cardiopulmonary bypass and intraoperative hypotension were associated with longer intensive care unit stay. Intraoperative hypotension and cerebral oxygen desaturation had no significant impact on mortality.
PPHN did not significantly affect perioperative morbidity and mortality in d-TGA patients, suggesting a more favorable prognosis than previously reported.