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
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)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Thoracic and Cardiovascular SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- 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
- Management of systemic right ventricular failure in patients with congenitally corrected transposition of the great arteries.Circulation. 2016; 134: 1293-1302
- 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
- Anatomic correction of atrioventricular discordance.J Thorac Cardiovasc Surg. 1993; 105: 1067-1076
- Senning plus arterial switch operation for discordant (congenitally corrected) transposition.Ann Thorac Surg. 1997; 64: 495-502
- Combined atrial and arterial switch procedure for congenital corrected transposition with ventricular septal defect.Heart. 1995; 73: 479-482
- 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
- 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
- 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
- A proportional hazards model for the subdistribution of a competing risk.J Am Stat Assoc. 1999; 94: 496-509
- Long-term outcome of surgically treated patients with corrected transposition of the great arteries.J Thorac Cardiovasc Surg. 2005; 129: 182-191
- Atrioventricular discordance: results of repair in 127 patients.J Thorac Cardiovasc Surg. 1999; 117: 1190-1203
- Results of the double switch operation for congenitally corrected transposition of the great arteries.Eur J Cardiothorac Surg. 2003; 24: 11-20
- Results of the double switch operation for congenitally corrected transposition of the great arteries.Eur J Cardiothorac Surg. 2009; 35: 879-884
- Anatomic repair for congenitally corrected transposition of the great arteries.J Thorac Cardiovasc Surg. 2009; 137: 404-412.e4
- 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
- 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
- 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
- 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
- Long-term prognosis of double-switch operation for congenitally corrected transposition of the great arteries.Eur J Cardiothorac Surg. 2012; 42: 1004-1008
- Two-stage operation for anatomical correction of transposition of the great arteries with intact interventricular septum.Lancet. 1977; 309: 1275-1278
- Left ventricular reconditioning and anatomical correction for systemic right ventricular dysfunction.Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2000; 3: 198-215
- 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
- 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
- Enhanced left ventricular training in corrected transposition of the great arteries by increasing the preload.Eur J Cardiothorac Surg. 2016; 49: 1571-1576
- Long-term predictors of aortic root dilation and aortic regurgitation after arterial switch operation.Circulation. 2004; 110: II128-II132
- 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
- Determinants of left ventricular dysfunction after anatomic repair of congenitally corrected transposition of the great arteries.Ann Thorac Surg. 2006; 82: 2059-2066
- 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
- Late left ventricular dysfunction after anatomic repair of congenitally corrected transposition of the great arteries.J Thorac Cardiovasc Surg. 2014; 148: 254-258
- Left ventricular retraining in corrected transposition: relationship between pressure and mass.J Thorac Cardiovasc Surg. 2020; 159: 2356-2366
- Impact of pacing on systemic ventricular function in L-transposition of the great arteries.J Thorac Cardiovasc Surg. 2016; 151: 131-139
- Successful neonatal double switch in symptomatic patients with congenitally corrected transposition of the great arteries.Ann Thorac Surg. 2008; 85: 1-2
- Neonatal double switch for congenitally corrected transposition with Ebstein anomaly and bilateral superior venae cavae.J Thorac Cardiovasc Surg. 2014; 148: e241-e242
- 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
Article info
Publication history
Published online: March 11, 2022
Accepted:
January 10,
2022
Received in revised form:
September 24,
2021
Received:
July 15,
2020
Identification
Copyright
© 2022 by The American Association for Thoracic Surgery
ScienceDirect
Access this article on ScienceDirectLinked Article
- Commentary: Time for a multi-institutional study for congenitally corrected transposition of great arteries?The Journal of Thoracic and Cardiovascular SurgeryVol. 164Issue 6
- PreviewChavez and colleagues1 present their outstanding outcomes of the double switch (DS) operation in 103 patients with congenitally corrected transposition of great arteries (cc-TGA). It provides strong evidence for the benefit of anatomical repair and that excellent midterm survival can be achieved with a consistent and aggressive approach to left ventricle retraining and correction at a young age (where possible).
- Full-Text
- Preview
