Surgical Outcomes in Patients Undergoing a Double Switch Operation for Corrected Transposition

Area of Science:

• Cardiology
• Pediatric Cardiology
• Congenital Heart Surgery

Background:

• Congenitally corrected transposition of the great arteries (CC-TGA) is a complex congenital heart defect.
• Previous physiologic repair methods for CC-TGA had disappointing outcomes, often leading to right ventricular dysfunction or tricuspid regurgitation.
• The double switch procedure has emerged as a surgical option for CC-TGA.

Purpose of the Study:

• To evaluate the surgical outcomes of the double switch procedure in patients with CC-TGA.
• To compare the outcomes of different surgical approaches within the double switch procedure.
• To assess the impact of prior left ventricular retraining on surgical results.

Main Methods:

• Retrospective review of 121 patients who underwent a double switch for CC-TGA between 2002 and 2023.
• Patients had a median age of 32 months at the time of surgery.
• Analysis included comparison between arterial switch and Rastelli procedures, and the role of prior left ventricular retraining.

Main Results:

• Overall in-hospital mortality was 3.3%, with higher rates for the Rastelli procedure (5.6%) compared to arterial switch (1.5%).
• At a median follow-up of 30 months, combined early and late mortality was 9.3% for Rastelli and 4.5% for arterial switch.
• 93% of discharged patients had normal or low-normal left ventricular function, and 96% had mild or less neoaortic insufficiency, with lower mortality in patients who underwent prior left ventricular retraining (2.0% vs 9.7%).

Conclusions:

• The double switch procedure demonstrates excellent short- and midterm surgical outcomes for CC-TGA.
• The arterial switch component of the double switch procedure is associated with a significantly lower mortality risk than the Rastelli procedure.
• Left ventricular retraining prior to double switch may be associated with improved survival outcomes.