Results of the double switch operation for congenitally corrected transposition of the great arteries

• Published in: European journal of cardio-thoracic surgery 2009-05, Vol.35 (5), p.879-884
• Main Authors: Ly, Mohamedou, Belli, Emre, Leobon, Bertrand, Kortas, Chokri, Grollmüss, Oswin E., Piot, Dominique, Planché, Claude, Serraf, Alain
• Format: Article
• Language: English
• Subjects: Algorithms; Arterial switch operation; Biological and medical sciences; Cardiac Pacing, Artificial; Cardiology. Vascular system; Child; Child, Preschool; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava; Congenitally corrected transposition; Double switch operation; Echocardiography, Doppler; Epidemiologic Methods; Heart; Heart Block - complications; Heart Block - therapy; Heart Septal Defects, Ventricular - complications; Humans; Infant; Medical sciences; Pneumology; Reoperation; Senning procedure; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Transposition of Great Vessels - complications; Transposition of Great Vessels - diagnostic imaging; Transposition of Great Vessels - surgery; Treatment Outcome
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2009.01.051

Background: Congenitally corrected TGA (CC-TGA) is characterized by discordant atrioventricular and ventriculo arterial connections. In absence of right ventricular outflow tract obstruction (RVOTO), repair by atrial and arterial switches remains a challenging procedure for which long term follow-up is uncertain. Methods: From 1995 to 2007, 20 patients (median age: 26 months) with CC-TGA had double switch procedure. Segmental anatomy was {SLL} in all patients, dextrocardia in two patients, mesocardia in two patients. Ventricular septal defect was present in 17 patients, aortic coarctation in 2 patients and interrupted aortic arch (IAoA) in 1 patient. Five patients had tricuspid valve regurgitation. Six patients had AV blocks, 4 patients had pacemaker implantation prior to repair. Pulmonary artery banding was performed in 17 patients, for congestive heart failure (14 patients) or left ventricular retraining (3 patients). Three patients, including one patient with IAoA had primary repair. After LV retraining, repair was performed when indexed LV mass to LV volume ratio was above 1.5. A median follow-up of 60 months was achieved in all. Results: There were no deaths. Postoperative pacemaker implantation was required in four patients. Reoperation for Senning obstruction was necessary in one patient, and pacemaker battery replacement in another patient. One patient had mild neoaortic insufficiency, two had mild tricuspid regurgitation and two had mild mitral regurgitation. All were in NYHA I–II. Actuarial survival at 10 years was 100% and freedom from reoperation at 5 and 10 years were 93% and 77.4%, respectively. Conclusion: Double switch for CC-TGA without RVOTO can be performed with no mortality and low morbidity. Since these results seem to last for several years, it should be considered as the optimal procedure.