The Ventricular Switch Procedure: Updated Outcomes And Lessons Learned
Nicholas A. Oh, MD, Tara Karamlou, MD, MSc, Malek Yaman, MD, Caroline Pennacchio, BS, Munir Ahmad, MD, Hani Najm, MD.
Cleveland Clinic Foundation, Cleveland, OH, USA.
Objectives:Complex congenital hearts, particularly heterotaxy, are often deemed “unseptatable” and unsuitable even for single ventricle palliation. We described a novel approach to utilize the left ventricle(LV) as the subpulmonary ventricle, termed ‘Ventricular Switch'. Our objective is to report our recent experience and highlight lessons learned. Methods:This is a retrospective review (2017-2023) of patients who underwent Ventricular Switch, which utilizes series of surgical techniques, resulting in a biventricular circulation with a subsystemic right ventricle(RV). These include, but not limited to, ventricular septation, atrial conversion/switch, bidirectional cavopulmonary shunt(BCPS), and LV to pulmonary artery(PA) conduit. Pre- and post-operative data were analyzed, focusing on modifications from iterative experience. Results:16 patients underwent Ventricular Switch. Median conversion age was 5.2 years (4months-47years). There was no 30-day mortality. Systemic saturation significantly improved post-operatively (80±6 vs 95±4,P<0.01). CVP was similarly reduced. Stabilization of systemic atrioventricular valves(AVV) with concomitant preemptive annuloplasty, PA-banding proximal to BCPS, and earlier and staged operation have paid dividends. At 1-year and 3-year follow-up, patients demonstrated stable biventricular function, well-functioning AVV, and improved symptoms. Conclusions:Our results demonstrate improvement in oxygen saturation, CVP, and stable ventricular function at follow-up. Our comprehensive experience suggests that successful Ventricular Switch requires normal pre-operative RV function and end-diastolic volumes to support pulmonary output. Systemic AVV competency is critical for satisfactory post-operative hemodynamics and outcomes. Elevated BCPS and left atrial pressures should be approached with caution. 
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