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Senning plus arterial switch operation for discordant (congenitally corrected) transposition
T R Karl1, R G Weintraub, C P Brizard
1Cardiac Surgical Unit, Royal Children's Hospital, Melbourne, Australia. cardiac@cryptic.rch.unimelb.edu.au
The Annals of Thoracic Surgery
|August 1, 1997
Summary
The Senning plus arterial switch operation offers a viable treatment for complex congenital heart defects like congenitally corrected transposition of the great arteries. This approach shows promising survival rates and improved heart function in selected pediatric patients.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Cardiac Physiology
Background:
- Congenitally corrected transposition of the great arteries (ccTGA) is a complex congenital heart defect.
- Often associated with ventricular septal defects, outflow tract obstruction, and tricuspid valve abnormalities.
- A subset of patients without left ventricular outflow tract obstruction undergo combined Senning and arterial switch procedures.
Purpose of the Study:
- To evaluate the efficacy and outcomes of the Senning plus arterial switch operation in patients with ccTGA.
- To assess the feasibility of this combined surgical approach in a challenging patient population.
Main Methods:
- Retrospective analysis of 14 patients undergoing Senning plus arterial switch operation since July 1989.
- Inclusion criteria focused on patients with ccTGA and contraindications to classic repair, such as right ventricular dysfunction or tricuspid insufficiency.
- Data collected on patient demographics, pre-operative conditions, surgical details, and post-operative outcomes.
Main Results:
- One hospital death (7%) in a neonate; 81% actuarial survival beyond 10 months.
- Significant reduction in tricuspid insufficiency (median grade from 3/4 to 1/4, p=0.003).
- Normal right ventricular function in 11/12 survivors, with most in New York Heart Association class I or II.
Conclusions:
- Senning plus arterial switch operation is a favorable option for selected ccTGA patients.
- Offers comparable or lower early risk than classic repair strategies.
- May help mitigate long-term complications associated with ccTGA.