%0 Journal Article
%T Surgical Outcomes in Patients Undergoing a Double Switch Operation for Corrected Transposition.
%A Mainwaring RD
%A Felmly LM
%A Ho DY
%A Arunamata A
%A Algaze C
%A Ma M
%A Hanley FL
%J Ann Thorac Surg
%V 0
%N 0
%D 2024 May 14
%M 38750683
%F 5.102
%R 10.1016/j.athoracsur.2024.04.022
%X <B>BACKGROUND: </B>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.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>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.