Letter:
To the Editor,
Okan Yurdakök MD et al.1’s recently published article ”The choice of
palliative arterial switch operation as an alternative for selected
cases in a single center: Experience and midterm results” piques our
interest. The authors’ efforts are significant and should be recognized
by the readers. The author’s final point is that palliative arterial
switch operation provides an effective outcome as an alternative
surgical procedure in children with univentricular physiology.
Furthermore, we agree that this procedure provides anatomical and
physiological benefits and prevents complications associated with other
surgical procedures such as the Damus–Kaye–Stansel (DKS) procedure.
Given the study’s limitations, we would like to highlight a few points
that would have improved the quality of this article and added to
existing knowledge.
The first major concern is the study’s validity, which is hampered by
the small sample size, which significantly reduces the study’s power.
The authors could have addressed this issue by enrolling a large number
of patients, which could have resulted in effective results.
Furthermore, this observational study was based on single-centred data,
which revealed a wide range of disparities due to differences in
socioeconomic status, race, and lifestyle. As a result, the authors
should have considered directing a multicentered data study. Thirdly, no
preoperative characteristics were specified, which could have provided
information about the patients’ suitability for this surgery. Jeffrey
S.Heinle MD et al.2 published a study in 2011 that included Nataka
index, McGoon ratio, mixed venous oxygen saturation, pulmonary
arteriolar resistance (Woods units), and transpulmonary gradient as
factors.
Furthermore, this study supplied better animation pictures, pulmonary
angiography, and ventriculogram details to better comprehend this
phenomenon, which might have been a major strength if the authors had
also provided this information. Fourth, no clear criteria or
instructions for considering this surgical technique were provided. For
example, a study found that the ratio of the bulboventricular foramen
(BVF) to the aortic annulus an indication for this procedure3. According
to this study, patients with a BVF to aortic annulus ratio of less than
0.8 are eligible for this surgery. In addition, the authors forgot to
include several factors that contribute to patient mortality during and
after surgery. For example, Sabine H Daebritz et al.4 identified
myocardial ischemia, sepsis, pneumonia, coagulopathy, and left
ventricular outflow tract obstruction as possible causes of mortality in
their research. Finally, innovative therapies and operations for
individuals with univentricular physiology should be used in order to
achieve effective results. Furthermore, cross-sectional and prospective
cohort studies should be preferred over retrospective research to avoid
the danger of recall bias.