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- Title
Outcomes of the anatomical repair in patients with congenitally corrected transposition of the great arteries: lessons learned in a high-volume centre.
- Authors
Lenoir, Marien; Bouhout, Ismail; Gaudin, Regis; Raisky, Olivier; Vouhé, Pascal
- Abstract
OBJECTIVES The physiological repair of the congenitally corrected transposition of the great arteries (ccTGA) has been associated with a long-term risk of the right ventricular dysfunction and tricuspid valve regurgitation. On the other side, the anatomical repair with the restoration of the left ventricle in a systemic position has been hypothesized to improve long-term outcomes. The aim of this study was to determine the results of the anatomical repair. METHODS Between 1990 and 2015, 39 patients underwent an anatomical repair of a ccTGA. The median age was 7 years (range from 8 days to 42.8 years). Eighteen (46%) patients had a double switch. Of these, 21 (54%) patients had an atrial switch with a Rastelli technique (n = 16, 41%), with a réparation à l’étage ventriculaire (REV) procedure (n = 4, 10%) or a truncal rotation (n = 1, 3%). The follow-up was 100% complete at 2 years with a median follow-up of 3.17 years (range 0–26 years). RESULTS The early mortality was 10% (n = 4) and the late mortality was 20% (n = 8). The long-term survival was 77 ± 10% at 10 years for the double switch group and 62 ± 11% at 10 years for the Rastelli group (P = 0.25). Eight (20%) patients required reintervention. Freedom from reoperation at 10 years was 82 ± 11% in the double switch group and 88 ± 11% in the Rastelli group. At the last follow-up, 23 (82%) patients were in New York Heart Association (NYHA) functional class I and 2 (7%) patients in NYHA class II. CONCLUSIONS The anatomical repair of the ccTGA is associated with significant early mortality and morbidity. However, the long-term functional status is satisfactory. The anatomical repair of the ccTGA should be reserved for a carefully selected group of patients.
- Subjects
RIGHT heart ventricle diseases; TRANSPOSITION of great vessels; HUMAN abnormalities; VENTRICULAR septal defects; AORTIC valve insufficiency treatment; THERAPEUTICS
- Publication
European Journal of Cardio-Thoracic Surgery, 2018, Vol 54, Issue 3, p532
- ISSN
1010-7940
- Publication type
Article
- DOI
10.1093/ejcts/ezy116