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This Article Full Text Full Text (PDF) CME: Take the activity for this article: Moderate versus deep hypothermia for ... Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Ardawan J. Rastan Thomas Walther Michael A. Borger Friedrich W. Mohr Martin Kostelka Permission Requests Google Scholar Articles by Rastan, A. J. Articles by Kostelka, M. PubMed Articles by Rastan, A. J. Articles by Kostelka, M. Related Collections Congenital - cyanotic Extracorporeal circulation Great vessels

Moderate versus deep hypothermia for the arterial switch operation — experience with 100 consecutive patients

^a Department of Cardiac Surgery, Heart Center, University of Leipzig, Struempellstr. 39, 04289 Leipzig, Germany
^b Department of Pediatric Cardiology, Heart Center, University of Leipzig, Struempellstr. 39, 04289 Leipzig, Germany

Received 10 September 2007; received in revised form 3 December 2007; accepted 20 December 2007.

^_* Corresponding author. Tel.: +49 341 865 1319; fax: +49 341 865 1452. (Email: rastan{at}rz.uni-leipzig.de).

Objectives: To evaluate the impact of moderate versus deep perioperative hypothermia on postoperative morbidity in patients receiving the arterial switch operation (ASO). Methods: One hundred consecutive patients received the ASO from 9/98 to 4/06 using temperature-corrected full-flow moderate (M > 24 °C, n = 51) or deep hypothermic cardiopulmonary bypass (CPB) (D <20 °C, n = 49). Complex TGA morphology was present in 33 patients (M: 27.4%, D: 38.8%, n.s.). Median age was 9 days (M) versus 10 days (D) and body weight was 3.5 ± 0.7 kg (M) versus 3.6 ± 0.9 kg (D) (both p = n.s.). Follow-up was 3.7 ± 2.1 years. Results: Lowest perioperative rectal temperature was 25.3 ± 1.1 °C (M) versus 19.0 ± 0.8 °C (D), p < 0.001. Intraoperative blood transfusion (M: 231 ± 47 ml, D: 252 ± 112 ml, p = 0.04) and postoperative lactate level (M: 3.2 ± 1.3 mmol/l, D: 3.8 ± 2.4 mmol/l, p = 0.02) were lower under moderate hypothermia. One patient (D) suffered myocardial ischemia, required ECMO support and died. All other patients were safely weaned from CPB using dopamine (M: 3.0 µg/kg min, D: 3.4 µg/kg min, n.s.) and dobutamine (M: 5.6 µg/kg min, D: 6.7 µg/kg min, p = 0.048). Secondary chest closure was performed in 41% (M) versus 59% (D) (p = 0.04). Patients were extubated after 89 h (M) versus 126 h (D) (p = 0.03). Under moderate hypothermia ICU stay (M: 8.4 ± 4.7 days, D: 12.0 ± 13.8 days, p = 0.03) and hospital stay (M: 12.8 ± 6.8 days, D: 20.7 ± 15.5 days, p = 0.001) were shorter. Five-year freedom from reoperation was 97.0% for simple and 85.2% for complex TGA with RVOT reconstruction in 4/6 patients. Conclusions: The ASO under full-flow moderate compared to deep hypothermia was advantageous regarding length of procedure and primary chest closure rate. Moderate hypothermia seemed to be beneficial for pulmonary recovery, length of chest tube drainage treatment and inotropic support. No worse early or long-term effects of moderate hypothermia were found.

Key Words: Arterial switch operation • Moderate hypothermia • Deep hypothermia • Circulatory arrest • Transposition of the great arteries