Double switch ameliyatları: Büyük arterlerin doğuştan düzeltilmiş transpozisyonunda fizyolojik düzeltme mi, anatomik düzeltme mi yapalım?

Doğuştan düzeltilmiş büyük arterlerin transpozisyonunun (cTGA) optimal cerrahi tedavisine yönelik arayışlar devam etmektedir. Fizyolojik (konvansiyonel) düzeltme yaklaşımlarında, morfolojik sağ ventrikülün (MRV) sistemik dolaşım tarafında kalıyor olması, özellikle geç dönemde, sistemik ventrikül ve triküspit kapak yetersizliği ile sonuçlanmaktadır. Double switch (anatomik düzeltme) ameliyatları ile morfolojik sol ventrikülün sistemik ventrikül, MRV’nin ise pulmonik ventrikül haline dönüştürülmesi amaçlanmıştır. Son 20 yılda double switch ameliyatlarının erken ve orta vadedeki sonuçlarının giderek iyileşmesi, anatomik düzeltmenin tercih edilen bir yöntem olmasına yol açmıştır. Anatomik düzeltme ile ventrikül fonksiyonlarının korunması sayesinde doğuştan cTGA’lı hastaların normal/normale yakın fonksiyonel kapasite ile daha uzun yaşama umutları artmıştır. Ancak kesin bir yargıya varabilmek için daha çok sayıda hastayı kapsayan, daha uzun süreli takipler içeren çalışmalara ihtiyaç vardır.

Double switch operations: Should we perform physiologic or anatomic repair in congenitally corrected transposition of the great arteries

The seeking for the optimal surgical treatment of congenitally corrected transposition of the great arteries (cTGA) is ongoing. Physiologic (conventional) repair approaches, leaving the morphologic right ventricle (MRV) on the systemic circulation side, cause systemic ventricle and tricuspid valve failure, particularly in the long-term. Double Switch operations (anatomic repair) were aimed to convert the morphologic left ventricle to systemic ventricle and MRV to pulmonic ventricle. Gradual improvement in the early and midterm results of double switch operations in the last 20 years rendered anatomic repair to become a preferred procedure. Thanks to the preservation of ventricular functions through anatomic repair, patients with congenitally cTGA may survive longer with normal/near normal functional capacity. However, studies with larger sample size and longer follow-up duration are required to establish a more definite judgement.

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