First Description of Double Switch Operation Including Senning and En-Bloc Rotation of Arterial Trunk for Congenitally Corrected Transposition and Pulmonary Stenosis: Excellent Early and Midterm Outcome

Background: En-bloc rotation of the arterial trunk (ERAT) was described for patients with complex dextro-transposition of the great arteries with ventricular septal defect and left ventricular outflow tract obstruction. We added the atrial switch procedure (AS) to the ERAT to adopt this technique for the repair of congenitally corrected transposition (cc-TGA) and pulmonary stenosis. We aimed to report our early/mid-term outcomes.

Method: A retrospective review was performed to identify cc-TGA patients undergoing AS and ERAT between March 2015 and March 2022. Preoperative baseline characteristics, procedural data as well as early/mid-term outcome measures were analyzed. Freedom from death and reoperation/reintervention were estimated using Kaplan–Meier time-to-event models.

Results: Out of 19 double-switch procedures, a total of 4 patients underwent atrial switch together with ERAT (21%). Median age and weight at surgery were 2.5 years (IQR: 0.9–4.7) and 12.8 kg (IQR: 9.4–17.8), respectively. Anatomic features of the patients were complex with severe left ventricular outflow tract obstruction being present in all patients. However, pulmonary valve function and coronary anatomy allowed for ERAT. Surgical technique was performed with no intra-operative complications, despite comparably long cardiopulmonary bypass and aortic cross-clamp times: median 373.3 (IQR: 341.5–397.3) and 219.5 (IQR: 211.8–244.5) minutes, respectively, except for one pacemaker implantation (25%, ¼) due to persisting atrioventricular block and one patient experiencing transient kidney failure. Median follow-up duration was 38.6 months (13.5–77.3) with no early or late deaths and no reinterventions/reoperations occurring so far. Median gradients of the right and left ventricular outflow tract at last visit were not hemodynamically relevant.

Conclusion: En-bloc rotation of the arterial trunk in combination with atrial switch for cc-TGA patients is a complex but feasible surgical technique in experienced hands. We display excellent early and mid-term outcomes in our small patient cohort. Nevertheless, longer follow-up durations and larger patient samples will prove, whether complex surgery will pay off with the anticipated benefits of reducing recurrent outflow tract interventions in the long term.

Publication History

Article published online:
28 January 2023