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Contemporary outcomes of the double switch operation for congenitally corrected transposition of the great arteries

      Abstract

      Objective

      To determine the contemporary outcomes of the double switch operation (DSO) (ie, Mustard or Senning + arterial switch).

      Methods

      A single-institution, retrospective review of all patients with congenitally corrected transposition of the great arteries undergoing a DSO.

      Results

      Between 1999 and 2019, 103 patients underwent DSO with a Mustard (n = 93) or Senning (n = 10) procedure. Segmental anatomy was (S, L, L) in 93 patients and (I, D, D) in 6 patients. Eight patients had heterotaxy and 71 patients had a ventricular septal defect. Median age was 2.1 years (range, 1.8 months-40 years), including 34 patients younger than age 1 year (33%). Median weight was 10.9 kg (range, 3.4-64 kg). Sixty-one patients had prior pulmonary artery bands for a median of 1.1 years (range, 14 days-12.9 years; interquartile range, 0.7-3.1 years). Median intensive care unit and hospital lengths of stay were 5 and 10 days, respectively. Median follow-up was 3.4 years (interquartile range, 1-9.8 years) and 5.2 years (interquartile range, 2.3-10.7 years) in 79 patients with >1 year follow-up. At latest follow-up, aortic, mitral, tricuspid valve regurgitation, and left ventricle dysfunction was less than moderate in 96%, 98%, 96%, and 93%, respectively. Seventeen patients underwent reoperation: neoaortic valve intervention (n = 10), baffle revision (n = 5), and ventricular septal defect closure (n = 4). At latest follow-up, 17 patients (17%) had a pacemaker and 27 (26%) had cardiac resynchronization therapy devices. There were 2 deaths and 2 transplants. Transplant-free survival was 94.6% at 5 years. Risk factors for death or transplant included longer cardiopulmonary bypass time and older age at DSO.

      Conclusions

      The outcomes of the DSO are promising. Earlier age at operation might favor better outcomes. Progressive neoaortic regurgitation and reinterventions on the neo-aortic valve are anticipated problems.

      Graphical abstract

      Key Words

      Abbreviations and Acronyms:

      AR (aortic regurgitation), ASD (atrial septal defect), ccTGA (congenitally corrected transposition of the great arteries), CPB (cardiopulmonary bypass), CRT (cardiac resynchronization therapy), DSO (double switch operation), d-TGA (dextro transposition of the great arteries), LVOTO (left ventricular outflow tract obstruction), PAB (pulmonary artery band), TR (tricuspid regurgitation), VSD (ventricular septal defect)
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      References

        • Tweddell J.S.
        What do we really know about the management of patients with congenitally corrected transposition of the great arteries?.
        J Thorac Cardiovasc Surg. 2017; 154: 1023-1025
        • Filippov A.A.
        • del Nido P.J.
        • Vasilyev N.V.
        Management of systemic right ventricular failure in patients with congenitally corrected transposition of the great arteries.
        Circulation. 2016; 134: 1293-1302
        • Ilbawi M.N.
        • DeLeon S.Y.
        • Backer C.L.
        • Duffy C.E.
        • Muster A.J.
        • Zales V.R.
        • et al.
        An alternative approach to the surgical management of physiologically corrected transposition with ventricular septal defect and pulmonary stenosis or atresia.
        J Thorac Cardiovasc Surg. 1990; 100: 410-415
        • Yamagishi M.
        • Imai Y.
        • Hoshino S.
        • Ishihara K.
        • Koh Y.
        • Nagatsu M.
        • et al.
        Anatomic correction of atrioventricular discordance.
        J Thorac Cardiovasc Surg. 1993; 105: 1067-1076
        • Karl T.R.
        • Weintraub R.G.
        • Brizard C.P.
        • Cochrane A.D.
        • Mee R.B.B.
        Senning plus arterial switch operation for discordant (congenitally corrected) transposition.
        Ann Thorac Surg. 1997; 64: 495-502
        • Stümper O.
        • Wright J.G.C.
        • De Giovanni J.V.
        • Silove E.D.
        • Sethia B.
        • Brawn W.J.
        Combined atrial and arterial switch procedure for congenital corrected transposition with ventricular septal defect.
        Heart. 1995; 73: 479-482
        • Winlaw D.S.
        • McGuirk S.P.
        • Balmer C.
        • Langley S.M.
        • Griselli M.
        • Stümper O.
        • et al.
        Intention-to-treat analysis of pulmonary artery banding in conditions with a morphological right ventricle in the systemic circulation with a view to anatomic biventricular repair.
        Circulation. 2005; 111: 405-411
        • Myers P.O.
        • Del Nido P.J.
        • Geva T.
        • Bautista-Hernandez V.
        • Chen P.
        • Mayer J.E.
        • et al.
        Impact of age and duration of banding on left ventricular preparation before anatomic repair for congenitally corrected transposition of the great arteries.
        Ann Thorac Surg. 2013; 96: 603-610
        • Cecchin F.
        • Frangini P.A.
        • Brown D.W.
        • Fynn-Thompson F.
        • Alexander M.E.
        • Triedman J.K.
        • et al.
        Cardiac resynchronization therapy (and multisite pacing) in pediatrics and congenital heart disease: five years experience in a single institution.
        J Cardiovasc Electrophysiol. 2009; 20: 58-65
        • Fine J.P.
        • Gray R.J.
        A proportional hazards model for the subdistribution of a competing risk.
        J Am Stat Assoc. 1999; 94: 496-509
        • Hraska V.
        • Duncan B.W.
        • Mayer J.E.
        • Freed M.
        • del Nido P.J.
        • Jonas R.A.
        Long-term outcome of surgically treated patients with corrected transposition of the great arteries.
        J Thorac Cardiovasc Surg. 2005; 129: 182-191
        • Yeh T.J.
        • Connelly M.S.
        • Coles J.G.
        • Webb G.D.
        • McLaughlin P.R.
        • Freedom R.M.
        • et al.
        Atrioventricular discordance: results of repair in 127 patients.
        J Thorac Cardiovasc Surg. 1999; 117: 1190-1203
        • Duncan B.W.
        • Mee R.B.B.B.
        • Mesia C.I.
        • Qureshi A.
        • Rosenthal G.L.
        • Seshadri S.G.
        • et al.
        Results of the double switch operation for congenitally corrected transposition of the great arteries.
        Eur J Cardiothorac Surg. 2003; 24: 11-20
        • Ly M.
        • Belli E.
        • Leobon B.
        • Kortas C.
        • Grollmüss O.E.
        • Piot D.
        • et al.
        Results of the double switch operation for congenitally corrected transposition of the great arteries.
        Eur J Cardiothorac Surg. 2009; 35: 879-884
        • Sharma R.
        • Talwar S.
        • Marwah A.
        • Shah S.
        • Maheshwari S.
        • Suresh P.
        • et al.
        Anatomic repair for congenitally corrected transposition of the great arteries.
        J Thorac Cardiovasc Surg. 2009; 137: 404-412.e4
        • Murtuza B.
        • Barron D.J.
        • Stumper O.
        • Stickley J.
        • Eaton D.
        • Jones T.J.
        • et al.
        Anatomic repair for congenitally corrected transposition of the great arteries: a single-institution 19-year experience.
        J Thorac Cardiovasc Surg. 2011; 142: 1348-1357.e1
        • Brizard C.P.
        • Lee A.
        • Zannino D.
        • Davis A.M.
        • Fricke T.A.
        • D'Udekem Y.
        • et al.
        Long-term results of anatomic correction for congenitally corrected transposition of the great arteries: a 19-year experience.
        J Thorac Cardiovasc Surg. 2017; 154: 256-265
        • Hraska V.
        • Mitchell M.E.
        • Woods R.K.
        • Frommelt M.A.
        What surgical improvements are needed to prove that anatomic repair is superior to physiologic repair in the majority of patients with corrected transposition of the great arteries?.
        J Thorac Cardiovasc Surg. 2017; 154: 1019-1022
        • Sun J.
        • Brizard C.
        • Winlaw D.
        • Alphonso N.
        • D'Udekem Y.
        • Eastaugh L.
        • et al.
        Biventricular repair versus Fontan completion for patients with d- or l-transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction.
        J Thorac Cardiovasc Surg. 2019; 158: 1158-1167.e1
        • Hiramatsu T.
        • Matsumura G.
        • Konuma T.
        • Yamazaki K.
        • Kurosawa H.
        • Imai Y.
        Long-term prognosis of double-switch operation for congenitally corrected transposition of the great arteries.
        Eur J Cardiothorac Surg. 2012; 42: 1004-1008
        • Yacoub M.H.
        • Radley-Smith R.
        • Maclaurin R.
        Two-stage operation for anatomical correction of transposition of the great arteries with intact interventricular septum.
        Lancet. 1977; 309: 1275-1278
        • Poirier N.C.
        • Mee R.B.B.
        Left ventricular reconditioning and anatomical correction for systemic right ventricular dysfunction.
        Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2000; 3: 198-215
        • Shin'oka T.
        • Kurosawa H.
        • Imai Y.
        • Aoki M.
        • Ishiyama M.
        • Sakamoto T.
        • et al.
        Outcomes of definitive surgical repair for congenitally corrected transposition of the great arteries or double outlet right ventricle with discordant atrioventricular connections: risk analyses in 189 patients.
        J Thorac Cardiovasc Surg. 2007; 133: 1318-1325
        • Cui B.
        • Li S.
        • Yan J.
        • Shen X.
        • Wang X.
        • Yang K.
        • et al.
        The results of a two-stage double switch operation for congenital corrected transposition of the great arteries with a deconditioned morphologically left ventricle.
        Interact Cardiovasc Thorac Surg. 2014; 19: 921-925
        • Zartner P.A.
        • Schneider M.B.
        • Asfour B.
        • Hraška V.
        Enhanced left ventricular training in corrected transposition of the great arteries by increasing the preload.
        Eur J Cardiothorac Surg. 2016; 49: 1571-1576
        • Schwartz M.L.
        Long-term predictors of aortic root dilation and aortic regurgitation after arterial switch operation.
        Circulation. 2004; 110: II128-II132
        • Langley S.M.
        • Winlaw D.S.
        • Stumper O.
        • Dhillon R.
        • de Giovanni J.V.
        • Wright J.G.
        • et al.
        Midterm results after restoration of the morphologically left ventricle to the systemic circulation in patients with congenitally corrected transposition of the great arteries.
        J Thorac Cardiovasc Surg. 2003; 125: 1229-1241
        • Bautista-Hernandez V.
        • Marx G.R.
        • Gauvreau K.
        • Mayer J.E.
        • Cecchin F.
        • del Nido P.J.
        Determinants of left ventricular dysfunction after anatomic repair of congenitally corrected transposition of the great arteries.
        Ann Thorac Surg. 2006; 82: 2059-2066
        • Quinn D.W.
        • McGuirk S.P.
        • Metha C.
        • Nightingale P.
        • de Giovanni J.V.
        • Dhillon R.
        • et al.
        The morphologic left ventricle that requires training by means of pulmonary artery banding before the double-switch procedure for congenitally corrected transposition of the great arteries is at risk of late dysfunction.
        J Thorac Cardiovasc Surg. 2008; 135: 1137-1144
        • Bautista-Hernandez V.
        • Myers P.O.
        • Cecchin F.
        • Marx G.R.
        • Del Nido P.J.
        Late left ventricular dysfunction after anatomic repair of congenitally corrected transposition of the great arteries.
        J Thorac Cardiovasc Surg. 2014; 148: 254-258
        • Mainwaring R.D.
        • Patrick W.L.
        • Arunamata A.
        • Chan F.
        • Newman B.
        • Rosenblatt T.R.
        • et al.
        Left ventricular retraining in corrected transposition: relationship between pressure and mass.
        J Thorac Cardiovasc Surg. 2020; 159: 2356-2366
        • Hofferberth S.C.
        • Alexander M.E.
        • Mah D.Y.
        • Bautista-Hernandez V.
        • Del Nido P.J.
        • Fynn-Thompson F.
        Impact of pacing on systemic ventricular function in L-transposition of the great arteries.
        J Thorac Cardiovasc Surg. 2016; 151: 131-139
        • Bautista-Hernandez V.
        • Serrano F.
        • Palacios J.M.
        • Caffarena J.M.
        • Bautista-Hernandez D.
        Successful neonatal double switch in symptomatic patients with congenitally corrected transposition of the great arteries.
        Ann Thorac Surg. 2008; 85: 1-2
        • Sebastian V.A.
        • Cooley A.
        • Ramaciotti C.
        • Guleserian K.J.
        • Forbess J.M.
        Neonatal double switch for congenitally corrected transposition with Ebstein anomaly and bilateral superior venae cavae.
        J Thorac Cardiovasc Surg. 2014; 148: e241-e242
        • Talwar S.
        • Ahmed T.
        • Saxena A.
        • Kothari S.S.
        • Juneja R.
        • Airan B.
        Morphology, surgical techniques, and outcomes in patients above 15 years undergoing surgery for congenitally corrected transposition of great arteries.
        World J Pediatr Congenit Heart Surg. 2013; 4: 271-277

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