Surgery for congenital heart disease
The morphologic left ventricle that requires training by means of pulmonary artery banding before the double-switch procedure for congenitally corrected transposition of the great arteries is at risk of late dysfunction

https://doi.org/10.1016/j.jtcvs.2008.02.017Get rights and content
Under an Elsevier user license
open archive

Objective

The aim of this study was to compare the outcome of the double-switch procedure for congenitally corrected transposition of the great arteries for patients completing morphologic left ventricle training by means of pulmonary artery banding with the outcome of patients whose morphologic left ventricle did not require training.

Methods

A retrospective study of all patients undergoing the double-switch procedure from 1991 through 2004 was performed. Patients were divided into 2 groups: those not requiring morphologic left ventricle training (n = 33) and those completing morphologic left ventricle training by means of pulmonary artery banding (n = 11).

Results

The time spent with the morphologic left ventricle conditioned at systemic pressures was longer for the group not requiring morphologic left ventricle training (median, 730 days; interquartile range, 399–1234 vs median, 436 days; interquartile range, 411–646; P = .19). The overall mortality (not requiring morphologic left ventricle training, 12.1%; requiring morphologic left ventricle training, 9.1%; P = 1) and rate of death/transplantation, development of moderate-to-severe morphologic left ventricle dysfunction, or both (not requiring morphologic left ventricle training, 21.2%; requiring morphologic left ventricle training, 45.5%; P = .14) were similar between groups. Actuarial freedom from death/transplantation with good morphologic left ventricular function was superior for patients whose morphologic left ventricle did not require training (P = .04). The follow-up was not different between groups (not requiring training: median, 1435 days [interquartile range, 285–2570 days]; requiring morphologic left ventricle training: median, 568 days [interquartile range, 399–1465 days]; P = .14). On multivariate analysis, the completion of morphologic left ventricle training predicted death/transplantation, development of moderate-to-severe morphologic left ventricle dysfunction, or both (P = .02).

Conclusions

The early results of the double-switch procedure in patients whose morphologic left ventricle required training compare favorably with those of patients whose morphologic left ventricle required no training. There is an increased risk of deterioration of morphologic left ventricle function over time in patients whose morphologic left ventricle requires training, and these patients need to be followed up regularly to detect this.

Abbreviations and Acronyms

AR
aortic regurgitation
CCF
congestive cardiac failure
CCTGA
congenitally corrected transposition of the great arteries
CPB
cardiopulmonary bypass
DS
double-switch
IQR
interquartile range
ITU
intensive therapy unit
mLV
morphologic left ventricle
mLVOTO
morphologic left ventricular outflow tract obstruction
mRV
morphologic right ventricle
neoAR
new aortic valve
PA
pulmonary artery
PHT
pulmonary hypertension
TR
tricuspid regurgitation
VSD
ventricular septal defect
95% CL
95% confidence limits

CTSNet Classification

20
21

Cited by (0)

Read at the Eighty-seventh Annual Meeting of The American Association for Thoracic Surgery, Washington, DC, May 5–7, 2007.