title: Midterm results after restoration of the morphologically left ventricle to the systemic circulation in patients with congenitally corrected transposition of the great arteries.
abstract: OBJECTIVE
  This study was undertaken to determine the outcomes of patients with congenitally corrected transposition of the great arteries after restoration of the morphologically left ventricle to the systemic circulation.
  
  
  METHODS
  Between November 1991 and June 2001, a total of 54 patients (median age 3.2 years, range 7 weeks-40 years) with either congenitally corrected transposition of the great arteries (n = 51) or atrioventricular discordance with double-outlet right ventricle (n = 3) underwent anatomic repair. This comprised a Senning procedure in all cases plus arterial switch (double-switch group) in 29 cases (53.7%), plus a Rastelli procedure (Rastelli-Senning group) in 22 cases (40.7%), and plus intraventricular rerouting (Senning-tunnel group) in 3 cases (5.6%). Left ventricular training by PA banding was performed before the double-switch operation in 9 of 29 cases (31%). Follow-up is complete (median 4.4 years).
  
  
  RESULTS
  Early mortality was 5.6% (n = 3), with 2 late deaths. Kaplan-Meier survivals (+/- SEM) were 94.4% +/- 3.1% at 1 year and 89.7% +/- 4.4% at 9 years. Survivals at 7 years were 84.9% +/- 7.1% in the double-switch group and 95.5% +/- 4.4% in the Rastelli-Senning group (P =.32). Of the 49 survivors, 46 (94%) were in New York Heart Association functional class I. Six have acquired new left ventricular dilatation or impaired systolic ventricular function. Four patients in the double-switch group had moderate aortic valve regurgitation develop, and 2 of them required valve replacement. Overall freedoms from reoperation at 1 and 9 years were 94.2% +/- 3.3% and 77.5% +/- 9.0%, with no significant difference between the groups (P =.60).
  
  
  CONCLUSIONS
  Anatomic repair of congenitally corrected transposition of the great arteries can be carried out with low early mortality. Excellent functional status can be achieved, with good midterm survival. Continued surveillance is necessary for patents with valved conduits and to determine the longer-term function of the aortic valve and the morphologically left ventricle in the systemic circulation.
authors.affiliation: Department of Cardiac Surgery, Diana Princess of Wales Children's Hospital, Birmingham, United Kingdom. Stephen.Langley@suht.swest.nhs.uk
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Langley
authors.forename: David S
authors.initials: DS
authors.lastname: Winlaw
authors.forename: Oliver
authors.initials: O
authors.lastname: Stumper
authors.forename: Rami
authors.initials: R
authors.lastname: Dhillon
authors.forename: Joseph V
authors.initials: JV
authors.lastname: De Giovanni
authors.forename: John G
authors.initials: JG
authors.lastname: Wright
authors.forename: Paul
authors.initials: P
authors.lastname: Miller
authors.forename: Babulal
authors.initials: B
authors.lastname: Sethia
authors.forename: David J
authors.initials: DJ
authors.lastname: Barron
authors.forename: William J
authors.initials: WJ
authors.lastname: Brawn
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D004310:Double Outlet Right Ventricle / Q000601:surgery; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D007223:Infant; D015996:Survival Rate; D013771:Tetralogy of Fallot / Q000601:surgery*; D014188:Transposition of Great Vessels / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome