Midterm outcome of surgical therapy for congenitally corrected transposition of the great arteries with morphologically involuted left ventricle / 中华心血管病杂志

ABSTRACT

<p><b>OBJECTIVE</b>We followed up all the patients underwent pulmonary artery banding (PAB) with or without the second stage double switch (DS) operation to compare the midterm outcomes between the DS and the prolonged palliative PAB.</p><p><b>METHODS</b>From January 2005 to June 2012, 40 consecutive patients diagnosed with congenital corrected transposition of the great arteries (cc-TGA) with morphologically involuted left ventricle were included in this retrospective cohort study. Every patient underwent the first stage PAB. The second stage DS was performed in 15 patients (DS group) and the palliative PAB was prolonged in the other 25 patients (PAB group). The median age at PAB was 3.1 years (range, 3 months to 8 years), weight was 11.5 kg (range, 5.0 kg to 21.5 kg). The patients were followed up after surgery.</p><p><b>RESULTS</b>Follow-up time was (3.4 ± 0.7) years. Overall mortality was 33.3% (5/15) in DS group and 4.0% (1/25) in PAB group (P < 0.05). The ratio of NYHAI-II was 80.0% (8/10) in DS group and 95.9% (23/24) in PAB group (P < 0.05) and the mean left ventricle ejection fraction was (51.4 ± 9.6)% in DS group and (61.0 ± 6.4)% in PAB group(P < 0.01) during follow up. There was no PAB related cyanosis or ventricular dysfunction and the trans-banding pressure gradient was (46.9 ± 21.5)mmHg (1 mmHg = 0.133 kPa) in PAB group. Echocardiography examination revealed moderate to large aortic regurgitation in 3 patients and severe post-double switch operative arrhythmias was found in 2 patients in DS group. The age at PAB (HR = 13.30, 95%CI6.28-14.02, P < 0.05) and left ventricle dysfunction (HR = 4.77, 95%CI2.71-8.68, P < 0.05) were identified as the risk factors for mortality after DS.</p><p><b>CONCLUSION</b>Compared to the DS, the prolonged palliative PAB procedure is associated with lower mortality and better cardiac function post operation.</p>