Results of the double switch operation in the current era

Background. In patients with atrioventricular and arterioventricular discor dance congenitally corrected transposition, the morphologically right ventr icle may progressively deteriorate while functioning in the systemic circui t. The double switch operation has been proposed to limit this functional d eterioration. Methods. From October 1993 to August 1998, the records of 27 patients with congenitally corrected transposition were reviewed. Age at operation ranged from 3 months to 55 years. Associated defects included ventricular septal defects in 18, pulmonary atresia in 7, and pulmonary stenosis in 11 patient s. Twenty-two patients had double switch operations (10 arterial switch plu s Senning procedures and 12 Rastelli plus Senning procedures). Five patient s were not candidates for the double switch. Before the double switch, 6 pa tients required pulmonary artery banding and 10 had functioning systemic to pulmonary artery or cavopulmonary shunts. Results. There was no early or late mortality. Two patients required pacema ker implantation, both later regained normal sinus rhythm. Tricuspid valve function improved in all patients except one. Moderate left ventricular dys function developed 5 months postoperatively in 1 patient. Conclusions. The double switch operation can be performed in selected patie nts with minimal early morbidity and mortality. Longer follow-up is necessa ry to determine whether this complex approach is indeed warranted. (Ann Tho rac Surg 2000;70:100-5) (C) 2000 by The Society of Thoracic Surgeons.