Abstract：
BACKGROUND: Congenitally corrected transposition of the great arteries (CC-TGA) is a rare and complex form of congenital heart disease. Results of physiologic repair proved disappointing due to late right ventricular dysfunction and/or tricuspid regurgitation. The current study was performed to evaluate surgical outcomes in patients undergoing a double switch for CC-TGA.
METHODS: This was a retrospective review of 121 patients who underwent a double switch over a 2-decade time frame (2002-2023). Patients were a median age of 32 months. Before the double switch, 49 of 121 patients (40%) had undergone left ventricular retraining.
RESULTS: Sixty-seven patients underwent an arterial switch, and 54 underwent a Rastelli procedure. There were 4 in-hospital deaths (3.3%), including 3 who had a Rastelli procedure (5.6%) and 1 who had an arterial switch (1.5%). At a median follow-up of 30 months, there were 4 late deaths (2 Rastelli and 2 arterial switch). Combined early and late mortality was 9.3% for the Rastelli and 4.5% for arterial switch. Combined mortality was 2.0% for patients who required left ventricular retraining vs 9.7% for those who did not. For the 117 patients discharged from the hospital, 93% have normal or low-normal left ventricular function, and 96% have mild or less neoaortic insufficiency.
CONCLUSIONS: Surgical outcomes in patients undergoing a double switch procedure have been excellent both in the short- and midterm. However, the Rastelli procedure was associated with a more than 2-fold increase in mortality risk compared with the arterial switch.
METHODS: This was a retrospective review of 121 patients who underwent a double switch over a 2-decade time frame (2002-2023). Patients were a median age of 32 months. Before the double switch, 49 of 121 patients (40%) had undergone left ventricular retraining.
RESULTS: Sixty-seven patients underwent an arterial switch, and 54 underwent a Rastelli procedure. There were 4 in-hospital deaths (3.3%), including 3 who had a Rastelli procedure (5.6%) and 1 who had an arterial switch (1.5%). At a median follow-up of 30 months, there were 4 late deaths (2 Rastelli and 2 arterial switch). Combined early and late mortality was 9.3% for the Rastelli and 4.5% for arterial switch. Combined mortality was 2.0% for patients who required left ventricular retraining vs 9.7% for those who did not. For the 117 patients discharged from the hospital, 93% have normal or low-normal left ventricular function, and 96% have mild or less neoaortic insufficiency.
CONCLUSIONS: Surgical outcomes in patients undergoing a double switch procedure have been excellent both in the short- and midterm. However, the Rastelli procedure was associated with a more than 2-fold increase in mortality risk compared with the arterial switch.
摘要：
背景：先天性矫正型大动脉转位（CC-TGA）是一种罕见且复杂的先天性心脏病。由于晚期右心室功能障碍和/或三尖瓣反流，生理修复的结果令人失望。本研究旨在评估接受CC-TGA双重转换的患者的手术效果。
方法：这是一项对121名在20年时间范围内（2002-2023年）进行双重转换的患者的回顾性研究。患者的中位年龄为32个月。121例患者中有49例（40％）在双重转换之前接受了左心室再训练。
结果：67例患者接受了动脉转换，54例患者接受了Rastelli手术。有4例住院死亡（3.3％），其中3例接受了Rastelli手术（5.6％），1例发生了动脉转换（1.5％）。中位随访30个月,已经有四例晚期死亡（两个Rastelli和两个动脉转换）。Rastelli的早期和晚期合并死亡率为9.3％，动脉转换为4.5％。需要左心室再训练的患者的综合死亡率为2.0％，而不需要左心室再训练的患者为9.7％。对于117名出院的病人，93％的人左心室功能正常或低正常，96％的人患有轻度或较少的新主动脉瓣关闭不全。
结论：接受双转换手术的患者在短期和中期的手术效果都非常好。然而,与动脉转换相比,Rastelli手术导致死亡风险增加2倍以上.
方法：这是一项对121名在20年时间范围内（2002-2023年）进行双重转换的患者的回顾性研究。患者的中位年龄为32个月。121例患者中有49例（40％）在双重转换之前接受了左心室再训练。
结果：67例患者接受了动脉转换，54例患者接受了Rastelli手术。有4例住院死亡（3.3％），其中3例接受了Rastelli手术（5.6％），1例发生了动脉转换（1.5％）。中位随访30个月,已经有四例晚期死亡（两个Rastelli和两个动脉转换）。Rastelli的早期和晚期合并死亡率为9.3％，动脉转换为4.5％。需要左心室再训练的患者的综合死亡率为2.0％，而不需要左心室再训练的患者为9.7％。对于117名出院的病人，93％的人左心室功能正常或低正常，96％的人患有轻度或较少的新主动脉瓣关闭不全。
结论：接受双转换手术的患者在短期和中期的手术效果都非常好。然而,与动脉转换相比,Rastelli手术导致死亡风险增加2倍以上.
