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.
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.