Midterm results after restoration of the morphologically left ventricle to the systemic circulation in patients with congenitally corrected transposition of the great arteries

Stephen M. Langley, David S. Winlaw, Oliver Stumper, Rami Dhillon, Joseph V. De Giovanni, John G. Wright, Paul Miller, Babulal Sethia, David J. Barron, William J. Brawn, Pedro J. Del Nido, Serafin Y. DeLeon, Thomas L. Spray, Gabor Bodor

Research output: Contribution to journalArticle

89 Citations (Scopus)

Abstract

Objective: This study was undertaken to determine the outcomes of patients with congenitally corrected transposition of the great-arteries after restoration of the morphologically left ventricle to the systemic circulation. Methods: Between November 1991 and June 2001, a total of 54 patients (median age 3.2 years, range 7 weeks-40 years) with either congenitally corrected transposition of the great arteries (n = 51) or atrioventricular discordance with double-outlet right ventricle (n = 3) underwent anatomic repair. This comprised a Senning procedure in all cases plus arterial switch (double-switch group) in 29 cases (53.7%), plus a Rastelli procedure (Rastelli-Senning group) in 22 cases (40.7%), and plus intraventricular rerouting (Senning-tunnel group) in 3 cases (5.6%). Left ventricular training by PA banding was performed before the double-switch operation in 9 of 29 cases (31%). Follow-up is complete (median 4.4 years). Results: Early mortality was 5.6% (n = 3), with 2 late deaths. Kaplan-Meier survivals (± SEM) were 94.4% ± 3.1% at 1 year and 89.7% ± 4.4% at 9 years. Survivals at 7 years were 84.9% ± 7.1% in the double-switch group and 95.5% ± 4.4% in the Rastelli-Senning group (P = .32). Of the 49 survivors, 46 (94%) were in New York Heart Association functional class I. Six have acquired new left ventricular dilatation or impaired systolic ventricular function. Four patients in the double-switch group had moderate aortic valve regurgitation develop, and 2 of them required valve replacement. Overall freedoms from reoperation at 1 and 9 years were 94.2% ± 3.3% and 77.5% ± 9.0%, with no significant difference between the groups (P = .60). Conclusions: Anatomic repair of congenitally corrected transposition of the great arteries can be carried out with low early mortality. Excellent functional status can be achieved, with good midterm survival. Continued surveillance is necessary for patents with valved conduits and to determine the longer-term function of the aortic valve and the morphologically left ventricle in the systemic circulation.

Original languageEnglish (US)
Pages (from-to)1229-1241
Number of pages13
JournalJournal of Thoracic and Cardiovascular Surgery
Volume125
Issue number6
DOIs
StatePublished - Jun 1 2003
Externally publishedYes

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Heart Ventricles
Survival
Double Outlet Right Ventricle
Patents
Aortic Valve Insufficiency
Ventricular Function
Mortality
Aortic Valve
Reoperation
Survivors
Dilatation
Congenitally corrected transposition of the great arteries
Arterial Switch Operation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Midterm results after restoration of the morphologically left ventricle to the systemic circulation in patients with congenitally corrected transposition of the great arteries. / Langley, Stephen M.; Winlaw, David S.; Stumper, Oliver; Dhillon, Rami; De Giovanni, Joseph V.; Wright, John G.; Miller, Paul; Sethia, Babulal; Barron, David J.; Brawn, William J.; Del Nido, Pedro J.; DeLeon, Serafin Y.; Spray, Thomas L.; Bodor, Gabor.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 125, No. 6, 01.06.2003, p. 1229-1241.

Research output: Contribution to journalArticle

Langley, SM, Winlaw, DS, Stumper, O, Dhillon, R, De Giovanni, JV, Wright, JG, Miller, P, Sethia, B, Barron, DJ, Brawn, WJ, Del Nido, PJ, DeLeon, SY, Spray, TL & Bodor, G 2003, 'Midterm results after restoration of the morphologically left ventricle to the systemic circulation in patients with congenitally corrected transposition of the great arteries', Journal of Thoracic and Cardiovascular Surgery, vol. 125, no. 6, pp. 1229-1241. https://doi.org/10.1016/S0022-5223(02)73246-7
Langley, Stephen M. ; Winlaw, David S. ; Stumper, Oliver ; Dhillon, Rami ; De Giovanni, Joseph V. ; Wright, John G. ; Miller, Paul ; Sethia, Babulal ; Barron, David J. ; Brawn, William J. ; Del Nido, Pedro J. ; DeLeon, Serafin Y. ; Spray, Thomas L. ; Bodor, Gabor. / Midterm results after restoration of the morphologically left ventricle to the systemic circulation in patients with congenitally corrected transposition of the great arteries. In: Journal of Thoracic and Cardiovascular Surgery. 2003 ; Vol. 125, No. 6. pp. 1229-1241.
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abstract = "Objective: This study was undertaken to determine the outcomes of patients with congenitally corrected transposition of the great-arteries after restoration of the morphologically left ventricle to the systemic circulation. Methods: Between November 1991 and June 2001, a total of 54 patients (median age 3.2 years, range 7 weeks-40 years) with either congenitally corrected transposition of the great arteries (n = 51) or atrioventricular discordance with double-outlet right ventricle (n = 3) underwent anatomic repair. This comprised a Senning procedure in all cases plus arterial switch (double-switch group) in 29 cases (53.7{\%}), plus a Rastelli procedure (Rastelli-Senning group) in 22 cases (40.7{\%}), and plus intraventricular rerouting (Senning-tunnel group) in 3 cases (5.6{\%}). Left ventricular training by PA banding was performed before the double-switch operation in 9 of 29 cases (31{\%}). Follow-up is complete (median 4.4 years). Results: Early mortality was 5.6{\%} (n = 3), with 2 late deaths. Kaplan-Meier survivals (± SEM) were 94.4{\%} ± 3.1{\%} at 1 year and 89.7{\%} ± 4.4{\%} at 9 years. Survivals at 7 years were 84.9{\%} ± 7.1{\%} in the double-switch group and 95.5{\%} ± 4.4{\%} in the Rastelli-Senning group (P = .32). Of the 49 survivors, 46 (94{\%}) were in New York Heart Association functional class I. Six have acquired new left ventricular dilatation or impaired systolic ventricular function. Four patients in the double-switch group had moderate aortic valve regurgitation develop, and 2 of them required valve replacement. Overall freedoms from reoperation at 1 and 9 years were 94.2{\%} ± 3.3{\%} and 77.5{\%} ± 9.0{\%}, with no significant difference between the groups (P = .60). Conclusions: Anatomic repair of congenitally corrected transposition of the great arteries can be carried out with low early mortality. Excellent functional status can be achieved, with good midterm survival. Continued surveillance is necessary for patents with valved conduits and to determine the longer-term function of the aortic valve and the morphologically left ventricle in the systemic circulation.",
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T1 - Midterm results after restoration of the morphologically left ventricle to the systemic circulation in patients with congenitally corrected transposition of the great arteries

AU - Langley, Stephen M.

AU - Winlaw, David S.

AU - Stumper, Oliver

AU - Dhillon, Rami

AU - De Giovanni, Joseph V.

AU - Wright, John G.

AU - Miller, Paul

AU - Sethia, Babulal

AU - Barron, David J.

AU - Brawn, William J.

AU - Del Nido, Pedro J.

AU - DeLeon, Serafin Y.

AU - Spray, Thomas L.

AU - Bodor, Gabor

PY - 2003/6/1

Y1 - 2003/6/1

N2 - Objective: This study was undertaken to determine the outcomes of patients with congenitally corrected transposition of the great-arteries after restoration of the morphologically left ventricle to the systemic circulation. Methods: Between November 1991 and June 2001, a total of 54 patients (median age 3.2 years, range 7 weeks-40 years) with either congenitally corrected transposition of the great arteries (n = 51) or atrioventricular discordance with double-outlet right ventricle (n = 3) underwent anatomic repair. This comprised a Senning procedure in all cases plus arterial switch (double-switch group) in 29 cases (53.7%), plus a Rastelli procedure (Rastelli-Senning group) in 22 cases (40.7%), and plus intraventricular rerouting (Senning-tunnel group) in 3 cases (5.6%). Left ventricular training by PA banding was performed before the double-switch operation in 9 of 29 cases (31%). Follow-up is complete (median 4.4 years). Results: Early mortality was 5.6% (n = 3), with 2 late deaths. Kaplan-Meier survivals (± SEM) were 94.4% ± 3.1% at 1 year and 89.7% ± 4.4% at 9 years. Survivals at 7 years were 84.9% ± 7.1% in the double-switch group and 95.5% ± 4.4% in the Rastelli-Senning group (P = .32). Of the 49 survivors, 46 (94%) were in New York Heart Association functional class I. Six have acquired new left ventricular dilatation or impaired systolic ventricular function. Four patients in the double-switch group had moderate aortic valve regurgitation develop, and 2 of them required valve replacement. Overall freedoms from reoperation at 1 and 9 years were 94.2% ± 3.3% and 77.5% ± 9.0%, with no significant difference between the groups (P = .60). Conclusions: Anatomic repair of congenitally corrected transposition of the great arteries can be carried out with low early mortality. Excellent functional status can be achieved, with good midterm survival. Continued surveillance is necessary for patents with valved conduits and to determine the longer-term function of the aortic valve and the morphologically left ventricle in the systemic circulation.

AB - Objective: This study was undertaken to determine the outcomes of patients with congenitally corrected transposition of the great-arteries after restoration of the morphologically left ventricle to the systemic circulation. Methods: Between November 1991 and June 2001, a total of 54 patients (median age 3.2 years, range 7 weeks-40 years) with either congenitally corrected transposition of the great arteries (n = 51) or atrioventricular discordance with double-outlet right ventricle (n = 3) underwent anatomic repair. This comprised a Senning procedure in all cases plus arterial switch (double-switch group) in 29 cases (53.7%), plus a Rastelli procedure (Rastelli-Senning group) in 22 cases (40.7%), and plus intraventricular rerouting (Senning-tunnel group) in 3 cases (5.6%). Left ventricular training by PA banding was performed before the double-switch operation in 9 of 29 cases (31%). Follow-up is complete (median 4.4 years). Results: Early mortality was 5.6% (n = 3), with 2 late deaths. Kaplan-Meier survivals (± SEM) were 94.4% ± 3.1% at 1 year and 89.7% ± 4.4% at 9 years. Survivals at 7 years were 84.9% ± 7.1% in the double-switch group and 95.5% ± 4.4% in the Rastelli-Senning group (P = .32). Of the 49 survivors, 46 (94%) were in New York Heart Association functional class I. Six have acquired new left ventricular dilatation or impaired systolic ventricular function. Four patients in the double-switch group had moderate aortic valve regurgitation develop, and 2 of them required valve replacement. Overall freedoms from reoperation at 1 and 9 years were 94.2% ± 3.3% and 77.5% ± 9.0%, with no significant difference between the groups (P = .60). Conclusions: Anatomic repair of congenitally corrected transposition of the great arteries can be carried out with low early mortality. Excellent functional status can be achieved, with good midterm survival. Continued surveillance is necessary for patents with valved conduits and to determine the longer-term function of the aortic valve and the morphologically left ventricle in the systemic circulation.

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