Double switch for congenitally corrected transposition of the great arteries1

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Abstract
Objective: To evaluate the early and medium term results of operations for congenitally corrected transposition of the great arteries (CCTGA) wherein the left ventricle becomes the systemic ventricle. Methods: Fourteen patients with CCTGA who underwent anatomic repair from 1994 to 1998 were placed in one of two groups: those without pulmonic stenosis (PS) (N=7) and those with PS (N=7). Main associations in the group without PS were: severe left atrioventricular (AV) valve regurgitation (N=4), ventricular septal defect (VSD) (N=4), criss-cross AV connection (N=1), and hypoplasia of the morphologic RV (N=1). Main associations in the group with PS were: VSD (N=7), anomalous pulmonary venous drainage (N=2) and major aorto-pulmonary collaterals (N=1). All patients in the group without PS underwent an arterial switch operation and all except one had a modified senning repair for atrial rerouting for anatomic correction. All seven patients with PS underwent a Rastelli repair and all except one needed a modified senning repair. Results: Early survivorship in both groups was 6/7. Follow-up ranges from 1 month to 48 months. The mean left ventricular ejection fraction (LVEF) in the arterial switch and senning patients was 65% and in the Rastelli and atrial rerouting was 52%. None of the survivors except one have any significant mitral regurgitation (MR). The one exception resulted from iatrogenic damage to a chorda during VSD closure. All except two patients are class I symptomatic and all are in normal sinus rhythm. Conclusion: Satisfactory early and mid term results of anatomic repair support the double switch option as the procedure of choice for patients of CCTGA amenable to biventricular repair.