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The Annals of Thoracic Surgery, Vol 56, 854-861, Copyright © 1993 by The Society of Thoracic Surgeons
AD Cochrane, TR Karl and RB Mee
Late failure of the systemic right ventricle is seen in up to 10% of
patients after atrial switch for transposition of the great arteries and in
patients with atrioventricular and ventriculoarterial discordance. Since
1981, 24 such patients have entered a program to achieve conversion to
arterial switch. The primary diagnoses were transposition of the great
arteries with ventricular septal defect (n = 10), transposition of the
great arteries with intact ventricular septum (n = 5), Taussig-Bing anomaly
(n = 4), and atrioventricular and ventriculoarterial discordance (n = 5).
The mean interval from atrial switch to right ventricular failure was 7
years. Four patients underwent direct conversion to arterial switch, with
one operative death. In 3 of these patients the initial left ventricular
pressure was high. The fourth patient was too sick to undergo banding, and
he required left ventricular assist device support after switch conversion.
The other 20 patients underwent 34 procedures to place or tighten a
pulmonary artery band to prepare the left ventricle to tolerate systemic
pressure. There was one band-related operative death. Twelve patients have
thus far gone on to switch conversion 13 days to 5 years (mean, 26 months)
after banding. In total, therefore, 16 patients have had an arterial switch
with atrial reconstruction. The early mortality for switch conversion was 2
of 16 (12.5%; 70% confidence limits, 4% and 27%), with one late death 12
months after operation. Including operative mortality, the 1-year actuarial
survival probability after conversion was 80% (70% confidence limits, 62%
and 92%). All survivors are asymptomatic.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Staged conversion to arterial switch for late failure of the systemic right ventricle
Victorian Pediatric Cardiac Surgery Unit, Royal Children's Hospital, Melbourne, Australia.
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