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Ann Thorac Surg 2001;71:1255-1259
© 2001 The Society of Thoracic Surgeons

Original article: cardiovascular

Systemic right ventricular failure after atrial switch operation: midterm results of conversion into an arterial switch

Sabine H. Daebritz, MDa, Andreas R. Tiete, MDa, Jörg S. Sachweh, MDa, Wolfgang Engelhardt, MDb, Götz von Bernuth, MDb, Bruno J. Messmer, MDa

a Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH, Aachen, Germany
b Department of Pediatric Cardiology, University Hospital RWTH, Aachen, Germany

Accepted for publication November 6, 2000.

Address reprint requests to Dr Daebritz, Department of Cardiac Surgery, LMU, University Hospital Grosshadern, Marchioninistr 15, D-81377 Munich, Germany
e-mail: sabine.daebritz{at}hch.med.uni-muenchen.de

Background. Failure of the systemic right ventricle after atrial switch operation can be treated by conversion into an arterial switch operation.

Methods. Four patients, age 38 to 59 months, presented with right ventricular failure after Senning operation and ventricular septal defect closure. One patient had elevated left ventricular pressure; in the other three patients the left ventricle was retrained to a left ventricular/right ventricular pressure ratio of 0.8 or greater by pulmonary artery banding in 12 to 24 months.

Results. Postoperative course after arterial switch operation was prolonged, but clinical condition was good at discharge. Fractional shortening ranged from 20% to 28%. Trace-to-moderate aortic regurgitation was present; only 1 patient had preserved sinus rhythm. After a mean follow-up of 43.5 months 1 patient had died due to left ventricular dysfunction. The survivors are in New York Heart Association functional class I to II. Fractional shortening has improved (29% to 37%); aortic regurgitation has not increased. No patient has undisturbed sinus rhythm.

Conclusions. Conversion of an atrial into an arterial switch is an alternative to cardiac transplantation in childhood. However, the procedure is demanding. Long-term morbidity is caused by rhythm disturbances. Aortic valve performance and left ventricular function require close observation.


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