The palliative arterial switch procedure for single ventricles: are these patients suitable Fontan candidates?
BACKGROUND
The traditional first stage of palliation for functional single-ventricle lesions with transposition of the great vessels and systemic outflow tract obstruction has been either the Norwood or Sano procedure or the Damus-Kaye-Stansel procedure. There is limited literature on the use of an arterial switch procedure as the initial staged palliation for functional single ventricles in this setting. This study is an examination of our institutional experience with performing the palliative switch procedure with examination of suitability for Fontan completion and midterm outcome in these patients.


METHODS
This is a retrospective review of our institutional experience from October 1991 through August 2006 on single-ventricle patients with transposition of the great vessels and systemic outflow tract obstruction who underwent a palliative arterial switch procedure.


RESULTS
Nine patients underwent an initial palliative switch procedure. Six of 9 patients underwent completion of palliation with the Fontan procedure and are alive and well. One patient is well and is awaiting the next stage of palliation (78%). There was 1 early operative death (11%) and 1 late death (11%). There was 1 case of recoarctation (11%).


CONCLUSIONS
The palliative switch procedure appears a reasonable surgical option for patients with functional single-ventricle lesions, transposition of the great vessels, and systemic outflow tract obstruction. Patients who have undergone a palliative switch procedure are suitable candidates for completion of palliation with the Fontan procedure.
Ceresnak
Scott R
SR
Department of Pediatrics, Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, New York, New York 10032, USA.
Quaegebeur
Jan M
JM
Pass
Robert H
RH
Hordof
Allan J
AJ
Liberman
Leonardo
L
D005260:Female; D018729:Fontan Procedure; D006352:Heart Ventricles / Q000002:abnormalities*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010166:Palliative Care; D018579:Patient Selection; D012189:Retrospective Studies; D014188:Transposition of Great Vessels / Q000601:surgery*