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Double-switch operation for congenitally corrected transposition

Y Imai1

  • 1Department of Pediatric Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College, Japan.

Advances in Cardiac Surgery
|January 1, 1997
PubMed
Summary
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The double-switch operation is a viable treatment for complex congenital heart defects, showing improved outcomes and ventricular function in pediatric patients with complete transposition of the great arteries.

Area of Science:

  • Pediatric Cardiology
  • Congenital Heart Surgery
  • Cardiac Anatomy

Background:

  • Congenitally corrected transposition of the great arteries (ccTGA) with atrioventricular (AV) discordance presents complex surgical challenges.
  • Anatomical correction, or the double-switch operation, offers a potential solution for these defects in pediatric patients.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of the double-switch operation in pediatric patients (<16 years) with ccTGA and AV discordance.
  • To assess the impact of the procedure on systemic tricuspid regurgitation and ventricular function.

Main Methods:

  • Retrospective analysis of 44 pediatric patients (<16 years) who underwent anatomical correction (double-switch operation) since June 1989.
  • Evaluation of preoperative and postoperative systemic tricuspid regurgitation and ventricular function.

Related Experiment Videos

  • Comparison with conventional Rastelli procedure outcomes.

    • Main Results:

    • A total of 44 patients underwent the double-switch operation, with a 9.1% in-hospital mortality rate.
    • Spontaneous improvement in tricuspid regurgitation was observed postoperatively due to anatomical right ventricular unloading.
    • Postoperative ventricular function was comparable to the conventional Rastelli procedure.
    • Combined atrial and arterial switch procedures in 9 patients resulted in 8 survivors in NYHA functional class 1.

    Conclusions:

    • The double-switch operation is indicated for complete transposition of the great arteries (CTGA), particularly with systemic tricuspid regurgitation or poor systemic right ventricular function.
    • Anatomical correction, including combined atrial and arterial switch procedures, is a preferable method for CTGA with VSD and pulmonary hypertension.