MedWire News: Patients with surgically corrected D-transposition of the great arteries (D-TGA) do not require invasive monitoring during general anesthesia for non-cardiac surgery, say US researchers.
Robert Christensen (University of Michigan Health Systems, Ann Arbor) and team reviewed the records of 50 patients with this “rare and complex” cardiac condition.
In theory, these patients, especially those who have undergone atrial switch repair, may be vulnerable to heart failure, arrhythmia, and sudden death.
But adverse events were, “in general, related to underlying comorbidities,” the team reports in the British Journal of Anaesthesia.
Seven of the patients were adults and 43 were children. Five patients had undergone atrial switch repair of D-TGA and the others had undergone arterial switch. Most patients were undergoing a low-severity surgical procedure and received outpatient care.
All atrial switch patients had residual heart defect and arrhythmia. These comorbidities were also present in, respectively, 67% and 7% of arterial switch patients. The patients also had high rates of pulmonary, renal, and neurologic defects.
Four patients suffered adverse events. They were aged between less than 1 and 15 years and had all undergone arterial switch repair. Two suffered failed extubation, one had severe bradycardia, and one suffered bleeding that required re-operation.
Christensen et al believe that only the bradycardia was related to the patient’s cardiac condition. The two instances of failed extubation were both probably caused by underlying pulmonary comorbidities (severe restrictive lung disease and laryngomalacia).
They conclude: “Given the significant incidence of adverse events, it remains imperative that each such case be carefully evaluated and the perioperative care be individualized based on the presence of comorbidities, type of repair, residual cardiac disease, severity of planned surgery, and experience of the provider.”
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