title: Left Ventricular Retraining and Late Arterial Switch for D-Transposition of the Great Arteries.
abstract: BACKGROUND
  For many decades, patients with d-transposition of the great arteries underwent an atrial switch procedure. Although many of these patients have continued to do well, a subset experience profound right ventricular failure. Some may be candidates for left ventricular (LV) retraining and late arterial switch. The purpose of this study was to review our experience with LV retraining and late arterial switch.
  
  
  METHODS
  This was a retrospective review of 32 patients with d-transposition. Thirty patients underwent a previous atrial switch and subsequently experienced right ventricular failure, whereas 2 presented late (8 months and 6 years) without previous intervention. The median age at the time of enrollment in this program was 15 years. Seven patients proceeded directly to late arterial switch owing to systemic LV pressures. The remaining 25 underwent a pulmonary artery band for LV retraining.
  
  
  RESULTS
  Twenty of the 32 (63%) patients enrolled in this program were able to undergo a late arterial switch. There were 2 operative mortalities (10%). Two additional patients survived surgery but died in the early outpatient time period. There has been no late mortality after the arterial switch with a median follow-up of 5 years. Twelve patients underwent one or more pulmonary artery band procedures without evidence of effective LV retraining. There have been 2 early and 3 late (42%) deaths in this subgroup.
  
  
  CONCLUSIONS
  The outcomes after arterial switch are encouraging and suggest that LV retraining and late arterial switch provide a viable option for this complex group of patients.
authors.affiliation: Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, California.
authors.forename: Naruhito
authors.initials: N
authors.lastname: Watanabe
authors.affiliation: Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, California. Electronic address: mainwaring@stanford.edu.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Mainwaring
authors.affiliation: Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, California.
authors.forename: Sergio A
authors.initials: SA
authors.lastname: Carrillo
authors.affiliation: Division of Pediatric Cardiology and Cardiovascular Medicine, Lucile Packard Children's Hospital/Stanford University, Stanford, California.
authors.forename: George K
authors.initials: GK
authors.lastname: Lui
authors.affiliation: Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, California.
authors.forename: V Mohan
authors.initials: VM
authors.lastname: Reddy
authors.affiliation: Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, California.
authors.forename: Frank L
authors.initials: FL
authors.lastname: Hanley
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D062186:Arterial Pressure; D002648:Child; D002675:Child, Preschool; D006801:Humans; D011651:Pulmonary Artery / Q000502:physiology / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D014188:Transposition of Great Vessels / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016277:Ventricular Function, Left / Q000502:physiology*; D017725:Ventricular Pressure / Q000502:physiology; D055815:Young Adult