Atrial switch (Senning procedure) in the era of the arterial switch operation: current indications and results

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Abstract
OBJECTIVE: Since 1990, the policy at Oregon Health Sciences Universityis to perform an arterial switch for all patients with transposition of thegreat arteries. In the last four years we have performed the Senningoperation in two patients. Our impression is that the long-term resultswith Senning procedure at our center are quite good. This prompted a reviewof our experience with this procedure. METHODS: A retrospective review ofall patients' charts was undertaken to document preoperative and operativeclinical variables. During follow-up, emphasis was placed on reviewing allcardiology clinic charts, transthoracic echocardiograms and ambulatoryholter monitor logs. Transthoracic echocardiograms and 24 hour Holtermonitoring were performed yearly on all patients during follow-up. RESULTS:Since September, 1982, 54 patients underwent the Senning operation fortransposition of the great arteries. All patients were palliated at birthwith the Rashkind atrial septostomy. The interatrial septum wasreconstructed with a dacron patch, and the systemic and pulmonary venousbaffles were constructed with autogenous atrial tissue. All but 2 patientsunderwent profound hypothermia and total circulatory arrest during theiroperative repair. Of 54 patients, early mortality occurred in 5 patients(9%). Follow-up is complete for the 49 operative survivors. The length offollow-up ranges from 6.0 months to 12.1 years (mean 6.4 +/- 0.5 years).There are no late deaths. Forty-five patients (94%) are in NYHA Class I.All late survivors are in sinus rhythm with brief episodes of junctionalrhythm (32 patients). CONCLUSIONS: Our series demonstrates that the Senningoperation can be safely performed in early infancy. Further, it providesexcellent symptomatic and clinical outcomes during late follow-up. Thus, inthe era of the arterial switch procedure, close and complete late follow-upresults with the Senning procedure, as in this series, should be consideredthe benchmark in the continued evaluation of the arterial switchoperation.

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