Open Access

ARTICLE

Risk factor analysis for a complicated postoperative course after neonatal arterial switch operation: The role of troponin T

Martin Christmann^1,2, Alexandra Wipf^1,2, Hitendu Dave^2,3, Daniel Quandt^1,2, Oliver Niesse^1,2, Markus Deisenberg^2,4, Martin Hersberger^2,5, Oliver Kretschmar^1,2, Walter Knirsch^1,2

1 Pediatric Cardiology, University Children’s Hospital, Zurich, Switzerland
2 Children’s Research Center, University of Zurich, Zurich, Switzerland
3 Division of Congenital Cardiovascular Surgery, University Children’s Hospital, Zurich, Switzerland
4 Department of Intensive Care Medicine and Neonatology, University Children’s Hospital, Zurich, Switzerland
5 Division of Clinical Chemistry and Biochemistry, University Children’s Hospital, Zurich, Switzerland

* Corresponding Author: Martin Christmann, MD, University Children’s Hospital, Pediatric Heart Center, Steinwiesstrasse 75, 8032 Zurich, Switzerland. Email:

Congenital Heart Disease 2018, 13(4), 594-601. https://doi.org/10.1111/chd.12615

Abstract

Objective: To find risk factors for a complicated early postoperative course after arterial switch operation (ASO) in neonates with d-transposition of the great arteries (dTGA). In addition to anatomical and surgical parameters, the predictive value of early postoperative troponin T (TnT) values in correlation to the early postoperative course after ASO is analyzed.
Methods: Seventy-nine neonates (57 (72%) male) with simple dTGA treated by ASO between 2009 and 2016 were included in the analysis. A complicated early postoperative course (30 days) was defined by one of the following criteria: (A) moderate to severe cardiac dysfunction without rhythm disturbances, (B) rhythm disturbances causing hemodynamic instability with the need for medical treatment, (C) signs for ischemia in ECG, (D) need for surgical or catheter interventional reinterventions other than diagnostic, or (E) other reasons.
Results: Forty of 79 patients (51%) showed a complicated early postoperative course after ASO, with 2 patients dying after 13 and 16 days. Patients with a complicated early postoperative course had a longer PICU stay (P < .001), needed longer mechanical ventilator support (P = .001) and longer inotropic support (P = .03), and more reinterventions (surgical or catheter interventional) were necessary (P = .001). Only the presence of a VSD (P = .001) and longer surgery duration (P = .026) were associated to a complicated postoperative course. TnT values only showed a trend toward higher values in patients with a complicated postoperative course (P = .06). A secondary rise in TnT was seen in 10 patients, ranging from 11.6% to 410.2%, of whom 7 could be classified in the complicated postoperative group.
Conclusions: The postoperative course after ASO in dTGA neonates is influenced by other cardiac comorbidities like a VSD with the need for surgical treatment, influencing surgery duration. Postoperative higher TnT values reflect a longer and more vulnerable intraoperative course with limited predictive value on the early postoperative course.

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