The Ventricular Switch Procedure Atlas: Adopting the Right Ventricle for the Systemic Circulation

Patients born with complex heterotaxy syndromes and patients with complex intra-cardiac connections are generally routed to univentricular pathways. This subgroup of patients typically carries poor long-term prognosis due to the frequent presence of unpartitioned atrioventricular valve and other morphological determinants that are associated with univentricular failure. Adopting the left ventricle in the systemic circulation would be the ideal choice if achievable. However, the presence of complex venous or arterial connections may make this infeasible. To overcome these limitations, we have introduced the concept of the “Ventricular Switch Procedure” (VSP) wherein the right ventricle is harnessed to serve as the systemic ventricle, while utilizing the left ventricle for the subpulmonary ventricle. The VSP paradigm offers prospect of a either a one-and-a-half or biventricular circulation for these patients. Here, we present 4 examples of complex congenital cardiac malformations and their surgical management to exemplify the principles of this surgical concept and illustrate how different techniques may be employed to achieve a right ventricle-based biventricular circulation.