Surgical Treatment And Progress Of Complex Congenital Correctional Transposition Of Great Arteries

Objective:To compare the long-term results between palliative pulmonary artery banding and anatomical correction for congenitally corrected transposition of the great arteries with regressed morphological left ventricle.Methods:From 2003 to 2012,40 consecutive patients underwent first stage pulmonary artery banding. The second stage operation-double switch was performed in 15 patients (double switch group). The other 25 patients retained the status of pulmonary artery banding and without further operation (pulmonary artery banding group). In-hospital mortality, long-term mortality and heart function were studied as primary outcomes.Results:The median time of follow-up was 3.4±0.7years (range,6 months to 9.5 years). Overall survival rate was 66.7% in double switch group vs.96.0% in pulmonary artery banding group (P=0.03). The ratio of NYHA Ⅰ-Ⅱ (80.0% vs.95.9%, P=0.02) and the mean functional left ventricle ejection fraction (51.4±9.6% vs. 61.0±6.4%, P=0.01) were higher in pulmonary artery banding group at follow up. In univariate analysis, the age at pulmonary artery banding was the only risk factor for late deaths (OR=7.30, P=0.01) and left ventricle dysfunction (OR=4.77, P=0.03) after the double switch. For patients who underwent prolonged pulmonary artery banding, the mean oxygen saturation was 95±3.1% and the trans-banding pressure gradient was 46.9±21.5mmHg.Conclusions:Pulmonary artery banding in congenital corrected transposed patients with deconditioned morphologic left ventricle may be considered as an ideal procedure by allowing left ventricle training while improving tricuspid regurgitation. Compared with the double switch procedure after pulmonary artery banding, the prolonged palliative pulmonary artery banding provided a lower mortality and indicated a better cardiac function.Objective:To report results of neo-aortic regurgitation after arterial switch for patients with complete transposition of the great arteries and corrected transposition of the great arteries.Methods:From 2003 to 2013,583 patients who underwent arterial switch operation for d-transposition and 31 patients who underwent double switch for corrected transposition were included. Since 2011, concomitant neo-aortic sino-tublar junction reconstruction was performed if the aorta and pulmonary artery discrepancy presented in patients with d-transposition.Results:The long-term survival rate was 92.5%(544(583) in patients with d-transposition and 74.2%(23/31) in patients with corrected transposition. More neo-aortic regurgitation developed in patients with corrected transposition than d-transposition. Moreover, the significant NAR (7.1%(38/539) versus 26.1%(6/23), P=0.010) and the aortic valve replacement (0.6%(3/539) versus 8.7%(2/23), P=0.003) were less d-transposition group. Previous pulmonary artery banding and two great arteries diameter discrepancy were identified as risk factors for significant NAR in patients with d-transposition; however, no risk factor was identified in patients with corrected transposition. With the application of neo-aortic sino-tubular junction reconstruction, no significant NAR was recorded in patients with two great vessels discrepancy.Conclusions:After arterial switch, favorable incidence of neo-aortic regurgitation and rare neo-aortic valve replacement are documented. Significant neo-aortic regurgitation associates with aorta-pulmonary discrepancy and previous pulmonary artery banding. Corrected transposition diagnosis itself may require additional attention. Patients with great vessels discrepancy may benefit from sino-tubular junction reconstruction.Objective:Outcomes of traditional double switch (Senning/Mustard+ASO/Rastelli) for congenitally corrected transposition of the great arteries associated with positional anomalies and left ventricular outflow tract obstruction currently remains far from satisfactory. This study was undertaken to assess the risks and benefits of the double-switch operation using a he mi-Mustard atrial switch procedure and the bidirectional Glenn operation for congenitally corrected transposition of the great arteries.Methods:Between January 2011 and September 2014,’The hemi-Mustard+ bidirectional Glenn+Rastelli procedure’ repair was achieved in 27 consecutive patients. All the patients were diagnosed with congenitally corrected transposition of the great arteries/cardiac malposition/left ventricular outflow tract obstruction (23 pulmonary stenosis and 4 pulmoanry atresia). The mean age at repair was 4.6±1.2 years. One patients had previous modified Blalock-Taussig shunt.Results:The mean aortic cross-clamp time was 161.1±24.5 min and the mean cardiopulmonary bypass time was 246.5±31.4 min. There was no in-hospital mortality. One patients required concomitant pacemaker implantation for preoperative complete heart block. The only 1 reoperation was caused by systemic venous obstruction. Postoperative pleura effusion was developed in 4 patients (14.8%). In uni-variate analysis, the pleura effusion was statistically correlated with the age at repair (P=0.003). Only 1 late death was documented. At the latest follow-up,24 patients (92.3%) were in NYHAI level and the mean LVEF was 67±13%.Conclusions:To repair congenital corrected transposition of the great arteries and cardiac malposition, favorable midterm results were achieved using The hemi-Mustard+bidirectional Glenn+Rastelli procedure. The main postoperative complication of this procedure is pleura effusion which is associated with the age at repair. Long-term follow-up is required.