Abruzzo Annie R, Beroukhim Rebecca S, Campos Sarah, Ghelani Sunil, Baird Christopher W, Feins Eric N, Del Nido Pedro J, Emani Sitaram M
Harvard Medical School, Boston, Mass.
Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Mass.
J Thorac Cardiovasc Surg. 2025 Mar;169(3):1012-1019. doi: 10.1016/j.jtcvs.2024.08.035. Epub 2024 Aug 31.
OBJECTIVE(S): This study investigates outcomes of the reverse double switch operation (R-DSO) and ventricular switch, novel approaches for patients with D-looped borderline left hearts that utilize the morphologic right ventricle as the systemic ventricle and the hypoplastic left ventricle as the subpulmonary ventricle.
This retrospective review analyzed early outcomes of children who underwent R-DSO/ventricular switch at a single institution between 2015 and 2023. Our primary end points were right ventricular (RV) function and tricuspid regurgitation. Secondary outcomes included mortality, reoperation, and perioperative complications.
Twenty-eight patients underwent either R-DSO (n = 19) or ventricular switch (n = 9). In 19 patients, a decompressing bidirectional cavopulmonary shunt was utilized, creating a reverse 1.5 switch. Median age at R-DSO/ventricular switch was 3.1 years (range, 9 months-12 years). At a median follow-up of 1.0 year (range, 38 days-7.2 years), no mortalities or heart transplants had occurred. Mild-moderate or greater RV dysfunction was detected in 4 patients, and mild-moderate or worse tricuspid regurgitation was also detected in 4 patients. Three patients required reoperations. Preoperative RV ejection fraction <55% was associated with higher incidence of postoperative RV dysfunction.
The R-DSO/VS strategy is an alternative to single-ventricle palliation or anatomic biventricular repair in the borderline left heart. Concerns for RV dysfunction and tricuspid regurgitation mandate close monitoring. Patients with preoperative RV dysfunction may be at risk for postoperative RV dysfunction. Further studies with longer follow-up are needed to delineate outcomes in comparison to the Fontan pathway and identify optimal candidates for this novel strategy.
本研究调查逆向双转换手术（R-DSO）和心室转换术的结果，这两种新方法用于D型环边左心患者，将形态学右心室用作体循环心室，发育不全的左心室用作肺下心室。
这项回顾性研究分析了2015年至2023年在单一机构接受R-DSO/心室转换术的儿童的早期结果。我们的主要终点是右心室（RV）功能和三尖瓣反流。次要结果包括死亡率、再次手术和围手术期并发症。
28例患者接受了R-DSO（n = 19）或心室转换术（n = 9）。在19例患者中，采用了减压双向腔肺分流术，形成了逆向1.5转换。R-DSO/心室转换术时的中位年龄为3.1岁（范围为9个月至12岁）。中位随访1.0年（范围为38天至7.2年），未发生死亡或心脏移植。4例患者检测到轻度至中度或更严重的RV功能障碍，4例患者也检测到轻度至中度或更严重的三尖瓣反流。3例患者需要再次手术。术前RV射血分数<55%与术后RV功能障碍的发生率较高相关。
R-DSO/VS策略是边缘性左心单心室姑息治疗或解剖性双心室修复的替代方法。对RV功能障碍和三尖瓣反流的担忧要求密切监测。术前RV功能障碍的患者术后可能有RV功能障碍的风险。需要进行更长时间随访的进一步研究，以描述与Fontan途径相比的结果，并确定这种新策略的最佳候选者。
