title: Atrial switch procedure in children more than 5 years of age: mid-term results.
abstract: In developing countries, where patients present late, the atrial switch operation is still a preferred palliation for d-transposition of great arteries (d-TGA). In this report, we present our experience in patients with d-TGA who were 5 years of age or older.
  
  
  
  Twenty-seven patients underwent an atrial switch procedure between January 2004 and December 2014. The standard technique consisted of a combination of the Senning and Mustard's repair with Schumacker's in situ modification for construction of the pulmonary venous baffle.
  
  
  
  The median age was 8 years (mean: 9.42 ± 4.9, range: 5-26 years). Anatomical variations were dextrocardia (n = 3), situs inversus (n = 3), juxtaposed atrial appendages (n = 4) and left superior vena cava (n = 6). Median aortic cross-clamp and bypass times were 63 and 105 min, respectively. The median ventilator support duration was 15 h (mean: 13.7 ± 4.3, range: 6-24 h). The median intensive care unit stay was 2 days (mean: 2.38 ± 0.69, range: 2-4 days). The median hospital stay was 6 days (mean: 6.3 ± 1.7, range: 4-12 days). There were no early or late deaths. The median follow-up duration was 46 months (mean: 55.15 ± 34.71, range: 1-124 months). There were no deaths or re-operations. One patient had mild systemic venous obstruction after 4 years; one underwent embolization of aortopulmonary collaterals after 5 years. The event-free survival rate at 124 months was 90.9 ± 6.13% (95% CI: 68.3-97.65).
  
  
  
  The atrial switch operation using the described technique is low risk, carries acceptable results and is a valuable management option in older patients with d-TGA and a regressed LV.
authors.affiliation: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India sachintalwar@hotmail.com.
authors.forename: Sachin
authors.initials: S
authors.lastname: Talwar
authors.affiliation: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Manikala Vinod
authors.initials: MV
authors.lastname: Kumar
authors.affiliation: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Amolkumar
authors.initials: A
authors.lastname: Bhoje
authors.affiliation: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Shiv Kumar
authors.initials: SK
authors.lastname: Choudhary
authors.affiliation: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Shyam Sunder
authors.initials: SS
authors.lastname: Kothari
authors.affiliation: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rajnish
authors.initials: R
authors.lastname: Juneja
authors.affiliation: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Anita
authors.initials: A
authors.lastname: Saxena
authors.affiliation: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Balram
authors.initials: B
authors.lastname: Airan
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000069278:Arterial Switch Operation; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D011667:Pulmonary Veins; D012189:Retrospective Studies; D014188:Transposition of Great Vessels / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Atrial switch operation; Left ventricular retraining; d-Transposition of great arteries