Half-turned truncal switch for transposition of the great arteries with left ventricular outflow tract obstruction

The Rastelli operation is accepted as 1 of the standard techniques for complete transposition of the great arteries (TGA) and TGA-type double-outlet right ventricle with left ventricular outflow tract (LVOT) obstruction. The half-turned truncal switch (HTTS) operation has been reported as an alternative to the Rastelli approach. The aim of this study was to compare these 2 operations for children with TGA and LVOT obstruction (TGA/LVOTO).

Between 2012 and 2024, 11 patients underwent TGA/LVOTO repair. The median age at repair was 12 months and median weight was 8.4 kg. Preoperative baseline and follow-up data were collected from records. Diagnosis was TGA with pulmonary stenosis in 7 cases, TGA-type double-outlet right ventricle in 4 cases. One patient had a hypoplastic right ventricle. Rastelli operation was performed in 6 patients, and 5 patients underwent the HTTS operation. The right ventricular outflow tract was augmented using a CorMatrix monocusp valve patch in 4 patients during HTTS operation, and Contegra (Medtronic) (n = 5) or pulmonary homograft (n = 1) valve during Rastelli operation.

There were no early deaths; all patients survived the procedure. The groups did not differ significantly in gender, age/weight/height in complete repair, previous surgical or transcatheter procedures, postoperative length of stay, genetic/syndromic abnormalities, and crossclamp time during complete repair. The mean cardiopulmonary bypass time was significantly longer for patients after HTTS (HTTS, 264 ± 24 minutes vs Rastelli, 174 ± 57 minutes; P = .01). The mean follow-up time was 5.2 ± 4.8 years (range, 1 month to 12 years). There was no significant difference between groups in follow-up time, pulmonary stenosis gradient, or degree of pulmonary or aortic insufficiency. Conduit reintervention was required in 4 patients from the Rastelli group and none in the HTTS group (Rastelli, 67% vs HTTS, 0%; P = .06).

Our study suggests that in children with TGA or TGA-type double-outlet right ventricle with LVOT obstruction, the half-turned truncal switch operation provides an unobstructed LVOT, results in less need for reintervention, and shows no disadvantage associated with right ventricular outflow tract growth at any anatomic level. Further investigation on this topic is needed.