Results of the double switch operation for congenitally corrected transposition of the great arteries.
OBJECTIVE
To determine the outcomes for a program that utilizes the double switch operation as the primary approach for congenitally corrected transposition.


METHODS
The records of 46 consecutive patients from a single institution who had undergone a double switch operation from October 1993 to March 2002 were reviewed. The records of 24 patients who were evaluated during the same period and felt not to be candidates for the double switch operation or who are awaiting double switch after pulmonary artery banding were also reviewed.


RESULTS
The median age at operation was 28 months (range 2 months to 16.3 years). Associated defects included ventricular septal defect 40, pulmonic stenosis 13 and pulmonary atresia 16. Twenty-six patients underwent an arterial switch operation combined with a Senning procedure while 20 patients underwent combined Rastelli and Senning procedures. Before the double switch, 12 patients had required pulmonary artery banding and 21 patients had systemic to pulmonary artery shunts. The median duration of stay in the intensive care unit was 3.5 days (range 2-60 days) and the median duration of total hospital stay was 8 days (range 5-60 days). There were no hospital deaths; one patient died 5 months after discharge due to an arrhythmogenic cardiac arrest during a median follow-up of 24 months [long-term survival 98% (95% CI 89-100%)].


CONCLUSIONS
The double switch operation may be performed with excellent hospital and long-term survival. The theoretical advantages of this procedure which enables the morphologic left ventricle and mitral valve to support a systemic pressure load must be established by careful follow-up of these patients.
Duncan
Brian W
BW
Pediatric and Congenital Heart Surgery, The Children's Hospital at The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA. duncanb@ccf.org
Mee
Roger B B
RB
Mesia
C Igor
CI
Qureshi
Athar
A
Rosenthal
Geoffrey L
GL
Seshadri
Shivaprakash G
SG
Lane
Geoffrey K
GK
Latson
Larry A
LA
D000293:Adolescent; D001011:Aorta / Q000601:surgery; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018579:Patient Selection; D011651:Pulmonary Artery / Q000601:surgery; D012086:Reoperation; D015996:Survival Rate; D014188:Transposition of Great Vessels / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome