Anaesthetic management and outcomes in patients with surgically corrected D-transposition of the great arteries undergoing non-cardiac surgery

摘要

Background. Patients with effective repair of D-transposition of the great arteries (D-TGA)nincreasingly present for non-cardiac surgery. These patients may be predisposed to heartnfailure, arrhythmias, and sudden death, especially after the atrial switch repair. This retrospectivenstudy was undertaken to review the care and outcomes of patients with D-TGA who presentednfor non-cardiac surgery.nMethods. Records for patients with surgically corrected D-TGA undergoing general anaesthesianfor non-cardiac surgery between October 2000 and April 2008 were reviewed. The anaesthesiologynrecords, operative note, admission history and physical examination records, andndischarge summaries of these patients were reviewed and the following data collected: patientncharacteristics; comorbidities; surgical procedure; anaesthetic and monitoring techniques;nintra- and postoperative complications; and admission status.nResults. Fifty procedures, including 43 in the paediatric setting and seven in the adult setting,ncomprised the final sample. The majority of these patients received anaesthesia on an outpatientnbasis in the paediatric hospital, without invasive monitoring and without complication. Therenwere four adverse events including a significant bradycardia, failed extubation after two of thenprocedures, and postoperative bleeding requiring return to the operating theatre in another.nConclusions. Data suggest that the majority of patients with surgically corrected D-TGA cannsafely undergo general anaesthesia, often as outpatients, with no invasive monitoring. However,ngiven the incidence of adverse events, it remains imperative that the perioperative care be individualizednbased on the presence of comorbidities, type of repair, residual cardiac disease, severitynof planned surgery, and experience of the provider.