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Eur J Cardiothorac Surg 2003;24:11-20
© 2003 Elsevier Science NL

Results of the double switch operation for congenitally corrected transposition of the great arteries

^a Pediatric and Congenital Heart Surgery, The Children's Hospital at The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
^b Pediatric Cardiology, The Children's Hospital at The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA

Received 27 September 2002; received in revised form 21 March 2003; accepted 25 March 2003.

^* Corresponding author. Tel.: +216-444-9365; fax: +216-445-3692
e-mail: duncanb{at}ccf.org

Objective: To determine the outcomes for a program that utilizes the double switch operation as the primary approach for congenitally corrected transposition. Methods: The records of 46 consecutive patients from a single institution who had undergone a double switch operation from October 1993 to March 2002 were reviewed. The records of 24 patients who were evaluated during the same period and felt not to be candidates for the double switch operation or who are awaiting double switch after pulmonary artery banding were also reviewed. Results: The median age at operation was 28 months (range 2 months to 16.3 years). Associated defects included ventricular septal defect 40, pulmonic stenosis 13 and pulmonary atresia 16. Twenty-six patients underwent an arterial switch operation combined with a Senning procedure while 20 patients underwent combined Rastelli and Senning procedures. Before the double switch, 12 patients had required pulmonary artery banding and 21 patients had systemic to pulmonary artery shunts. The median duration of stay in the intensive care unit was 3.5 days (range 2–60 days) and the median duration of total hospital stay was 8 days (range 5–60 days). There were no hospital deaths; one patient died 5 months after discharge due to an arrhythmogenic cardiac arrest during a median follow-up of 24 months [long-term survival 98% (95% CI 89–100%)]. Conclusions: The double switch operation may be performed with excellent hospital and long-term survival. The theoretical advantages of this procedure which enables the morphologic left ventricle and mitral valve to support a systemic pressure load must be established by careful follow-up of these patients.

Key Words: Congenitally corrected transposition • Double switch operation • Senning procedure • Rastelli procedure • Arterial switch operation

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