ABSTRACT
Congenital heart lesions are among the most common birth defects. The arterial switch procedure requires minimal intracardiac exposure, so either support technique can be employed with equal facility. This unique aspect of the repair of d-transposition of the great arteries by arterial switch allowed randomization of patients to either support technique without generating concomitant changes in surgical methods that might alter the outcome. Perfusion methods, including the extracorporeal circuit and apparatus, perfusate, adjunctive drugs, and use of the alpha-stat method of acid-base management, were identical for both groups except. Randomization schemes were developed using a permuted blocks design; the support method was assigned immediately prior to surgery. Treatment assignment was directly observed by the surgeons, anesthesiologists, perfusionists, study nurse, and electroencephalogram technician, as well as, occasionally, by the intensivist. Perfusion pressures and flow rates during rewarming were the same in both groups. Anesthetic management was standardized for all patients. Patients were cooled to a rectal temperature of 18°C.
