Single Center Experience with the Senning Procedure in the Current Era

• Published in: Seminars in thoracic and cardiovascular surgery 2016, Vol.28 (2), p.514-520
• Main Authors: Ferro, Giuseppe, MD, Murthy, Raghav, MD, Sebastian, Vinod A., MD, Guleserian, Kristine J., MD, Forbess, Joseph M., MD
• Format: Article
• Language: English
• Subjects: Adolescent; Arterial switch; Arterial Switch Operation - adverse effects; Arterial Switch Operation - mortality; Atrial switch; Cardiac Pacing, Artificial; Cardiothoracic Surgery; Child; Child, Preschool; Corrected Transposition; Disease-Free Survival; Double switch; Female; Heart Block - diagnosis; Heart Block - etiology; Heart Block - therapy; Heart Transplantation; Humans; Infant; Infant, Newborn; Kaplan-Meier Estimate; Male; Pacemaker, Artificial; Patient Selection; Rastelli operation; Reoperation; Retrospective Studies; Risk Assessment; Risk Factors; Texas; Time Factors; Transposition of Great Vessels - diagnosis; Transposition of Great Vessels - mortality; Transposition of Great Vessels - physiopathology; Transposition of Great Vessels - surgery; Treatment Outcome; Vascular Patency; Ventricular Dysfunction, Left - etiology
• ISSN: 1043-0679; 1532-9488
• DOI: 10.1053/j.semtcvs.2015.12.013

Objective The Senning procedure is an operative technique for atrial inversion in congenital heart anomalies. We sought to evaluate our contemporary outcomes employing this technique. Methods A retrospective analysis of all patients who underwent the Senning procedure at our institution was performed. Hospital records were reviewed, and follow-up data were obtained to evaluate outcomes. Results Nineteen patients underwent a Senning procedure between August 2005 and July 2014. Median age at repair was 594 days (range 5 days-15 years). Of those, 7 patients underwent a combined Senning-Rastelli operation and 10 underwent a double switch operation (arterial switch/atrial switch). Primary diagnosis was congenitally corrected transposition of the great arteries (cc-TGA) in 17 patients. Associated lesions included ventricular septal defect ( n =10), pulmonary stenosis/atresia ( n =7), and Ebstein's anomaly of the tricuspid valve ( n =4). There was one operative death (5%). Two patients required superior vena cava baffle revision in the operating room. No new pulmonary venous or systemic venous baffle obstruction was observed during follow-up. Five patients (26%) developed heart block requiring pacemaker implantation. Actuarial survival was 81% at 5 years with a median follow-up of 38 months. Two patients in the cc-TGA group were subsequently transplanted. Surviving patients ( n =15) are all well at last clinical follow-up, the majority with normal biventricular function. Conclusions The Senning procedure offers excellent outcomes with regard to systemic and pulmonary venous baffle patency. Results in patients with cc-TGA, however, are affected by significant early mortality after Senning-Rastelli and incidence of left ventricular dysfunction after double switch; which should be considered during patient selection and surgical planning. Abstract mini We evaluated outcomes after Senning procedure in a contemporary series. Nineteen patients underwent the procedure between August 2005 and July 2014. There was one operative death (5%). Outcomes with regard to venous baffles patency were excellent. Results after double switch and Senning-Rastelli procedures, however, were affected by significant mortality and morbidity.