Arterial switch and neurological outcomes: a retrospective study of medical records

Shah, Ekta G, Wilson, Sarah ML, Yao, Yi, Li, Wen, Filipek, Pauline A, Koerner, Taylor S, Salazar, Jorge D, Findley, Tina O and Corno, Antonio F ORCID: https://orcid.org/0000-0003-4374-0992 (2025) Arterial switch and neurological outcomes: a retrospective study of medical records. Regenerative Medicine Reports. ISSN 3050-6808

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Abstract

Despite being uncommon, survivors of neonatal cardiac surgery for complex congenital heart defects may face delays in various developmental domains, along with persistent subtle neurological deficits throughout their lifetime. Research is ongoing to determine the full extent and scope of these impairments. This study was performed to investigate neonatal and perioperative factors associated with neurodevelopmental differences in neonates who underwent arterial switch operation for transposition of the great arteries. Data collected retrospectively from neonates undergoing arterial switch operation from September 2017 to August 2020 at a single, quaternary institution, included perinatal history, perioperative data, and outpatient documentation. Primary outcome measures were neurological outcomes. The results showed that 26 neonates (65% male, 17/26) were included in this study, with a mean gestational age of 38 weeks (range 32–41 weeks) and a median birth weight of 3.3 kg (range 1.86–4.74 kg). Racial demographics included Caucasian in 8/26 (30.8%), Black in 2/26 (7.7%), Asian in 1/26 (3.8%), biracial in 9/26 (34.6%), and unspecified in 6/26 (23.1%). 46% (12/26) were of Hispanic ethnicity. No participant had a genetic diagnosis. Cardiac diagnoses included transposition of the great arteries with intact ventricular septum (17/26, 65%), with ventricular septal defect (8/26, 31%), and with double outlet right ventricle (1/26, 4%). Prenatal detection occurred in 12/26 (46%) patients. High-risk mortality risk factors, as categorized by Society of Thoracic Surgery Congenital Heart Surgery Database, were present in 22/26 (85%). Balloon atrio-septostomy was performed in 16/26 (62%). Arterial switch operation was performed at a mean age of 7.7 days (range 3–39 days). The average oxygen saturation 24 hours before BAS was 69% (range 50–87%), and the average oxygen saturation 24 hours before the arterial switch operation was 85% (range 75–92%). The mean cardiopulmonary bypass duration was 252 minutes (range 125–460 minutes), and the mean aortic cross-clamp duration was 138 minutes (range 61–266 minutes). No neonates required extracorporeal membrane oxygenation perioperatively. A shorter duration of cardiopulmonary bypass (P = 0.004) and cross-clamp time (P = 0.015) and the need for BAS (P = 0.043) were significantly associated with developmental delay in early childhood. The Apgar score, birth weight, microcephaly, need for preoperative mechanical ventilation, and age at the time of the arterial switch operation were not associated with developmental delay. The survival rate was 100% at a median follow-up of 3 years (range 2–5 years). These findings suggest that an arterial switch for transposition of the great arteries can be performed with satisfactory outcomes; however, this study supports the need for more neurodevelopmental-focused care through both the neonatal period and long-term follow-up. Neurodevelopmental monitoring of high-risk neonates with transposition of the great arteries before and after cardiac interventions is critically important, as it guides decisions on the need for advanced neuroimaging and the risk for neurodevelopmental impairments in the long term.