Comparison of half-turned truncal switch and conventional operations

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Medical Imaging

Background:

• Complete transposition of the great arteries (TGA) with left ventricular outflow tract (LVOT) obstruction presents complex surgical challenges.
• Conventional surgical procedures may lead to significant long-term complications, including reoperations for outflow tract issues.

Purpose of the Study:

• To compare the efficacy of the half-turned truncal switch operation (HTTSO) against conventional procedures for TGA with LVOT obstruction.
• To evaluate postoperative hemodynamics and long-term outcomes using advanced imaging techniques.

Main Methods:

• Retrospective analysis of patients undergoing conventional procedures (Rastelli, Réparation a l'étage ventriculaire) versus HTTSO.
• Postoperative hemodynamic assessment using time-resolved 3-dimensional magnetic resonance phase-contrast imaging (4D Flow MRI).

Main Results:

• Patients in the conventional group (n=3) required reoperations for outflow tract obstruction/insufficiency and experienced atrioventricular block.
• HTTSO patients (n=16) did not require reoperations for LVOT/right ventricular outflow tract obstruction.
• 4D Flow MRI revealed higher energy loss and wall shear stress in the winding LVOT of the conventional group, versus lower values in the straight LVOT of the HTTSO group.

Conclusions:

• HTTSO facilitates a straighter and wider LVOT, leading to superior long-term outcomes.
• HTTSO is recommended as the preferred surgical approach for TGA with LVOT obstruction.