Atrial switch (Senning procedure) in the era of the arterial switch operation: Current indications and results

Objective. Since 1990, the policy at Oregon Health Sciences University is to perform an arterial switch for all patients with transposition of the great arteries. In the last four years we have performed the Senning operation in two patients. Our impression is that the long-term results with the Senning procedure at our center are quite good. This prompted a review of our experience with this procedure. Methods. A retrospective review of all patients' charts was undertaken to document preoperative and operative clinical variables. During follow-up, emphasis was placed on reviewing all cardiology clinic charts, transthoracic echocardiograms and ambulatory holter monitor logs. Transthoracic echocardiograms and 24 hour Holter monitoring were performed yearly on all patients during follow-up. Results. Since September, 1982, 54 patients underwent the Senning operation for transposition of the great arteries. All patients were palliated at birth with the Rashkind atrial septostomy. The interatrial septum was reconstructed with a dacron patch, and the systemic and pulmonary venous baffles were constructed with autogenous atrial tissue. All but 2 patients underwent profound hypothermia and total circulatory arrest during their operative repair. Of 54 patients, early mortality occurred in 5 patients (9%). Follow-up is complete for the 49 operative survivors. The length of follow-up ranges from 6.0 months to 12.1 years (mean 6.4 +/- 0.5 years). There are no late deaths. Forty-five patients (94%) are in NYHA Class I. All late survivors are in sinus rhythm with brief episodes of junctional rhythm (32 patients). Conclusions. Our series demonstrates that the Senning operation can be safely performed in early infancy. Further, it provides excellent symptomatic and clinical outcomes during late follow-up. Thus, in the era of the arterial switch procedure, close and complete late follow-up results with the Senning procedure, as in this series, should be considered the benchmark in the continued evaluation of the arterial switch operation.