Objectives: Atrial switch procedures for transposition of the great arteries are associated with reoperations mainly for systemic ventricular dysfunction and baffle complications. This study aims at identifying the results of reoperations following the Senning operation.
Methods: Records of 314 hospital survivors who had undergone the Senning operation were reviewed for details concerning cardiac reoperations.
Results: Reoperations were required in 32 patients (systemic ventricular failure n=12, baffle complications n=11, left ventricular outflow tract obstruction n=7, aortic coarctation n=2) during a mean follow-up time of 18.2+/-5.7 years. Freedom from reoperation and survival at 25 years was 88.0+/-2.1% and 90.9+/-2.3%, respectively. Among patients who underwent reoperation for systemic ventricular failure (arterial switch and Senning take-down without prior pulmonary artery banding n=2, with prior banding n=3, banding without conversion n=4, tricuspid valve repair n=3), two patients died at the time of arterial switch and Senning take-down, and two patients died 4 and 16 months after tricuspid valve repair, respectively. Mean follow-up time after the first reoperation was 7.7+/-5.9 years. Survival after reoperation for systemic ventricular failure at 30 days, 1 year, and 10 years, was 91.7+/-8.0%, 83.3+/-10.8%, and 64.8+/-14.3%, respectively. Survival after reoperation for baffle complications and left ventricular outflow tract obstruction at 10 years was 85.7+/-13.2% and 83.3+/-15.2%, respectively.
Conclusions: Reoperations following the Senning operation are rare. Reoperations for baffle complications or left ventricular outflow tract obstruction can be performed with good results in the mid-term. However, reoperations for systemic ventricular failure are demanding, and are associated with a high operative and mid-term mortality.