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

Background. Failure of the systemic right ventricle after atrial switch ope ration can be treated by conversion into an arterial switch operation. Methods. Four patients, age 38 to 59 months, presented with right ventricul ar failure after Senning operation and ventricular septal defect closure. O ne patient had elevated left ventricular pressure; in the other three patie nts the left ventricle was retrained to a left ventricular/right ventricula r 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 range d 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 month s 1 patient had died due to left ventricular dysfunction. The survivors are in New York Heart Association functional class I to II. Fractional shorten ing has improved (29% to 37%); aortic regurgitation has not increased. No p atient has undisturbed sinus rhythm. Conclusions. Conversion of an atrial into an arterial switch is an alternat ive to cardiac transplantation in childhood. However, the procedure is dema nding. Long-term morbidity is caused by rhythm disturbances. Aortic valve p erformance and left ventricular function require close observation. (C) 200 1 by The Society of Thoracic Surgeons.