Ventricular switch procedure: updated outcomes and lessons learned.

Abstract

Objectives: Complex congenital hearts could be deemed 'unseptatable' or unsuitable for biventricular circulation. We described our novel approach to utilize the left ventricle (LV) as the sub-pulmonary ventricle, termed 'ventricular switch'. We report our updated experience and highlight lessons learned.

Methods: This is a retrospective cohort study (2016-2023) of patients who underwent ventricular switch, which utilizes series of surgical techniques resulting in a biventricular circulation with a sub-systemic right ventricle (RV). These patients were selected when LV-based biventricular repair was not feasible, or with a failing single-ventricle physiology. The majority of these cases are complex heterotaxy with complex systemic and pulmonary connections. Pre- and postoperative data were analysed, focusing on modifications from iterative experience.

Results: Seventeen patients underwent ventricular switch. Median conversion age was 5.2 years (4 months-47 years). Three (17%) had an operative mortality. Systemic saturation significantly improved postoperatively (79 ± 6 vs 94 ± 4, P = 0.008). Elevated central venous pressure (CVP) decreased by 13 mmHg ± 5 postoperatively. Eleven out of 17 (65%) patients underwent preemptive atrioventricular valve (AVV) repair as part of the procedure, and all maintained or improved AVV function postoperatively. One-year and 5-year survival was 79% and 72%, respectively. Patients demonstrated stable biventricular function, well-functioning AVV and improved symptoms.

Conclusions: Ventricular switch can be an option in complex lesions that are not amenable to LV based biventricular circulation. Our results demonstrate improvement in oxygen saturation, CVP and stable ventricular function at follow-up. Our experience suggests that systemic AVV competency is critical for satisfactory postoperative haemodynamics and outcomes. Successful surgery requires normal preoperative RV function and end-diastolic volumes.