Clinical experience of left ventricle retraining before arterial switch

Objective To investigate the clinical results of left ventricle retraining procedure. Methods From Apr. 2001 to May 2004, 7 consecutive cases of simple TGA underwent left ventricle retraining procedure, which was composed of aorto-pulmonary shunt and pulmonary artery banding. At the operation, the ratio of systolic pulmonary/systemic pressure increased from 0.34 to 0.76. Contemporary atrial septum excision was performed in 2 cases and pulmonary artery banding revision in one. Results There was no hospital death in this series. 4 cases underwent second stage arteries switch operation (ASO) successfully 2 weeks after primary retraining procedure and discharged uneventfully. 1 case was readmitted 3 months later for ASO and died of postoperative hepatic failure. 2 cases were discharged without second staged operation because of postoperative complications. Conclusion Left ventricle retraining is necessary preparation for ASO in cases of simple TGA beyond the neonatal period. Atrial communication plays an important role in left ventricle retraining procedure. The surgical results of rapid two-stage ASO are quite satisfactory.