Atrial switch procedure in children more than 5 years of age: mid-term results

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.