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Mac Felmly L, Mainwaring RD, Ho DY, Arunamata A, Algaze C, Hanley FL. Results of the Double Switch Operation in Patients Who Previously Underwent Left Ventricular Retraining. World J Pediatr Congenit Heart Surg 2024; 15:279-286. [PMID: 38321756 DOI: 10.1177/21501351231224329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND Congenitally corrected transposition of the great arteries (CC-TGA) is a complex form of congenital heart disease that has numerous subtypes. While most patients with CC-TGA have a large ventricular septal defect (VSD) and pulmonary stenosis, there are some patients who have either no VSD or a highly restrictive VSD. These patients will require left ventricular (LV) retraining prior to double switch. The purpose of this study was to review our experience with the double switch procedure in patients who had previously undergone LV retraining. METHODS This was a retrospective review of a single institution experience with the double switch procedure in patients who had undergone LV retraining (2002-present). RESULTS Forty-five patients underwent double switch following LV retraining. Of these, 39 had an arterial switch with hemi-Mustard/bidirectional Glenn and six had a Senning. The median cross-clamp time was 135 min (range 71-272) and median bypass time was 202 min (range 140-430 min). Median hospital length of stay was eight days (range 4-108). There were no in-hospital deaths. Median duration of follow-up was 30 months (range 0-175). One patient subsequently underwent heart transplantation and died 65 months following double switch. At follow-up, 41 of the 44 survivors (93%) have normal or low normal LV function and 40 of the 44 survivors (91%) have no or trace mitral regurgitation. CONCLUSIONS The data demonstrate early and mid-term survival of 100% and 97%. Ninety-three percent had preserved LV function. These results suggest that patients with CC-TGA who undergo LV retraining and double switch can have excellent clinical outcomes.
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Affiliation(s)
- L Mac Felmly
- Divisions of Pediatric Cardiac Surgery, Stanford Children's Hospital, Stanford, CA, USA
| | - Richard D Mainwaring
- Divisions of Pediatric Cardiac Surgery, Stanford Children's Hospital, Stanford, CA, USA
| | - Deborah Y Ho
- Pediatric Cardiology, Stanford Children's Hospital, Stanford, CA, USA
| | - Alisa Arunamata
- Pediatric Cardiology, Stanford Children's Hospital, Stanford, CA, USA
| | - Claudia Algaze
- Pediatric Cardiology, Stanford Children's Hospital, Stanford, CA, USA
| | - Frank L Hanley
- Divisions of Pediatric Cardiac Surgery, Stanford Children's Hospital, Stanford, CA, USA
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Chowdhury UK, Anderson RH, Spicer DE, George N, Sankhyan LK, Pandey NN, Goja S, Chandhirasekar B. Transposition physiology in the setting of concordant ventriculo-arterial connections. J Card Surg 2022; 37:2823-2834. [PMID: 35717625 DOI: 10.1111/jocs.16688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/23/2022] [Accepted: 05/09/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM To review the anatomical details, diagnostic challenges, associated cardiovascular anomalies, and techniques and outcomes of management, including re-interventions, for the rare instances of transposition physiology with concordant ventriculo-arterial connections. METHODS We reviewed clinical and necropsy studies on diagnosis and surgical treatment of individuals with transposition physiology and concordant ventriculo-arterial connections, analyzing also individuals with comparable flow patterns in the setting of isomerism. RESULTS Among reported cases, just over two-thirds were diagnosed during surgery, after initial palliation, or after necropsy. Of the patients, four-fifths presented in infancy with either cyanosis or congestive cardiac failure, with complex associated cardiac malformations. Nearly half had ventricular septal defects, and one-fifth had abnormalities of the tricuspid valve, including hypoplasia of the morphologically right ventricle. A small minority had common atrioventricular junctions We included cases reported with isomerism when the flow patterns were comparable, although the atrioventricular connections are mixed in this setting. Management mostly involved construction of intraatrial baffles, along with correction of coexisting anomalies, either together or multistaged. Overall mortality was 25%, with one-fifth of patients requiring pacemakers for surgically-induced heart block. The majority of survivors were in good functional state. CONCLUSIONS The flow patterns produced by discordant atrioventricular and concordant ventriculo-arterial connections remain an important, albeit rare, indication for atrial redirection or hemi-Mustard's procedure with bidirectional Glenn. The procedure recruits the morphologically left ventricle in the systemic circuit, producing good long-term functional results. The approach can also be used for those with isomeric atrial appendages and comparable hemodynamic circuits.
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Affiliation(s)
- Ujjwal Kumar Chowdhury
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Robert H Anderson
- Institute of Biomedical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Diane E Spicer
- Department of Pediatric Cardiology, Heart Institute, Johns Hopkins All Children's Hospital, University of Florida, Gainesville, Florida, USA
| | - Niwin George
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Lakshmi Kumari Sankhyan
- Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, Bilaspur, India
| | | | - Shikha Goja
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Balaji Chandhirasekar
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
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Left ventricular retraining in corrected transposition: Relationship between pressure and mass. J Thorac Cardiovasc Surg 2020; 159:2356-2366. [DOI: 10.1016/j.jtcvs.2019.10.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 10/01/2019] [Accepted: 10/09/2019] [Indexed: 01/19/2023]
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Ma M, Mainwaring RD, Hanley FL. Corrected Transposition: Anatomic Repair Using the Hemi-Mustard Atrial Baffle and Bidirectional Superior Cavopulmonary Connection. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2019; 22:51-56. [PMID: 31027564 DOI: 10.1053/j.pcsu.2019.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 02/04/2019] [Indexed: 11/11/2022]
Abstract
Anatomic repair for congenitally corrected transposition requires thoughtful surgical planning at both initial (neonatal or late) presentation, and during definitive repair. An algorithmic approach to the overall management of this lesion, with its many associated intracardiac anomalies, is presented. Modified atrial switch with bidirectional superior cavopulmonary connection is commonly utilized and demonstrates favorable results through a 20-year experience. Herein, technical considerations learned during the implementation of this strategy are described and emphasize the concept, in selected cases, of native pulmonary root preservation by translocation as an adjunct that is uniquely suited by adopting this approach.
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Affiliation(s)
- Michael Ma
- Department of Cardiothoracic Surgery, Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, California.
| | - Richard D Mainwaring
- Department of Cardiothoracic Surgery, Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, California
| | - Frank L Hanley
- Department of Cardiothoracic Surgery, Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, California
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Mainwaring RD, Patrick WL, Ibrahimiye AN, Watanabe N, Lui GK, Hanley FL. An Analysis of Left Ventricular Retraining in Patients With Dextro- and Levo-Transposition of the Great Arteries. Ann Thorac Surg 2018; 105:823-829. [DOI: 10.1016/j.athoracsur.2017.11.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/13/2017] [Accepted: 11/16/2017] [Indexed: 11/30/2022]
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Ibrahimiye AN, Mainwaring RD, Patrick WL, Downey L, Yarlagadda V, Hanley FL. Left Ventricular Retraining and Double Switch in Patients With Congenitally Corrected Transposition of the Great Arteries. World J Pediatr Congenit Heart Surg 2017; 8:203-209. [PMID: 28329464 DOI: 10.1177/2150135116683939] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Congenitally corrected transposition of the great arteries (CC-TGA) is a complex form of congenital heart defect with numerous anatomic subgroups. The majority of patients with CC-TGA are excellent candidates for a double-switch procedure. However, in the absence of an unrestrictive ventricular septal defect or subpulmonary stenosis, the left ventricle (LV) may undergo involution and require retraining prior to double switch. The purpose of this study was to review our experience with patients having CC-TGA who required LV retraining prior to a double-switch procedure. METHODS This was a retrospective review of 24 patients with CC-TGA who were enrolled in an LV retraining program in preparation for a double-switch procedure. The median age at the time of enrollment for retraining was 11 months (range 1 month-24 years). The average left ventricle to right ventricle pressure ratio was 0.39 ± 0.07 prior to intervention. All 24 patients underwent placement of an initial pulmonary artery band (PAB) for LV retraining. RESULTS Eighteen (75%) of the 24 patients underwent a double-switch procedure with no operative mortality. Of these 18 patients, 9 had a single PAB and 9 required a second band for retraining. Six patients have not undergone a double-switch procedure to date. Five patients are good candidates for a double switch and are 2 weeks, 3 weeks, 4 weeks, 8 months, and 35 months since their last PAB. One patient died from a noncardiac cause 26 months after PAB retightening. The 18 patients who underwent a double switch were followed for an average of 5 ± 1 years (range 0.1-10.3 years). There has been no late mortality, and only 2 patients required further reinterventions. CONCLUSION The data demonstrate that LV retraining has been highly effective in this select group of patients with CC-TGA. The data also demonstrate that the results of the double-switch procedure have been excellent at midterm follow-up. These results suggest that LV retraining and double switch offer a reliable strategy option for patients with CC-TGA.
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Affiliation(s)
- Ali N Ibrahimiye
- 1 Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA
| | - Richard D Mainwaring
- 1 Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA
| | - William L Patrick
- 1 Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA
| | - Laura Downey
- 2 Division of Pediatric Anesthesiology, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA
| | - Vamsi Yarlagadda
- 3 Division of Pediatric Cardiology, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA
| | - Frank L Hanley
- 1 Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA
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Lee CH, Choi ES, Cho S, Park SJ. Anatomic Repair Including Hemi-Mustard in Congenitally Corrected Transposition of the Great Arteries: What We know and Still Need to Know. Korean Circ J 2017; 47:173-175. [PMID: 28382070 PMCID: PMC5378021 DOI: 10.4070/kcj.2017.0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/24/2017] [Indexed: 11/21/2022] Open
Affiliation(s)
- Chang-Ha Lee
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Korea
| | - Eun Seok Choi
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Korea
| | - Sungkyu Cho
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Korea
| | - Su-Jin Park
- Department of Pediatrics, Sejong General Hospital, Bucheon, Korea
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Zeigler S, Mainwaring RD, Punn R, Petrossian E, Hanley FL. Double-Switch Repair of Corrected Transposition in Association With Criss-Cross Atrial Morphology. Ann Thorac Surg 2016; 101:1208-10. [PMID: 26897215 DOI: 10.1016/j.athoracsur.2015.08.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 08/13/2015] [Accepted: 08/17/2015] [Indexed: 11/25/2022]
Abstract
Corrected transposition is a relatively uncommon congenital heart defect characterized by discordance at both the atrioventricular and ventriculoarterial levels. A rare subset of patients with corrected transposition also have criss-cross atrial morphology. We report the surgical treatment of 2 patients with corrected transposition in association with criss-cross atrial morphology, emphasizing the novel atrial baffle required for this operation.
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Affiliation(s)
- Sanford Zeigler
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, California
| | - Richard D Mainwaring
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, California.
| | - Rajesh Punn
- Pediatric Cardiology, Lucile Packard Children's Hospital/Stanford University, Stanford, California
| | - Edwin Petrossian
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, California
| | - Frank L Hanley
- Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, California
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El-Zein C, Subramanian S, Ilbawi M. Evolution of the surgical approach to congenitally corrected transposition of the great arteries. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2015; 18:25-33. [PMID: 25939839 DOI: 10.1053/j.pcsu.2014.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 12/05/2014] [Indexed: 11/11/2022]
Abstract
The traditional surgical approach (physiologic repair) of congenitally corrected transposition of the great arteries (ccTGA) attempts at restoring normal physiology by repairing the associated lesions. It fails to address the most serious anatomic abnormality, mainly ventriculoarterial discordance, and results in less than optimal long-term outcomes. Anatomic repair was introduced to incorporate the left ventricle into the systemic circulation. The excellent short-term and intermediate results of the double switch operation and its modifications make it the procedure of choice for the treatment of ccTGA.
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Affiliation(s)
- Chawki El-Zein
- Division of Pediatric Cardiovascular Surgery, Advocate Children's Hospital, and the Department of Surgery, University of Illinois, Chicago, IL
| | - Sujata Subramanian
- Division of Pediatric Cardiovascular Surgery, Advocate Children's Hospital, and the Department of Surgery, University of Illinois, Chicago, IL
| | - Michel Ilbawi
- Division of Pediatric Cardiovascular Surgery, Advocate Children's Hospital, and the Department of Surgery, University of Illinois, Chicago, IL.
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Watanabe N, Mainwaring RD, Carrillo SA, Lui GK, Reddy VM, Hanley FL. Left Ventricular Retraining and Late Arterial Switch for d-Transposition of the Great Arteries. Ann Thorac Surg 2015; 99:1655-61; discussion 1661-3. [DOI: 10.1016/j.athoracsur.2014.12.084] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 12/20/2014] [Accepted: 12/30/2014] [Indexed: 11/25/2022]
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