Abstract
Objective
We aimed to evaluate the long-term results of physiologic repair for associated lesions of congenitally corrected transposition of great arteries (ccTGA) and to provide a basis for comparison with anatomic repair for this entity.
Subjects and methods
Sixteen ccTGA patients who underwent physiologic repair from 1970 to 2000 comprise this retrospective study. Conventional Rastelli procedure was performed in 12 patients with pulmonary stenosis or atresia (PS/PA). Ventricular septal defect closure was carried out in 2 patients, atrial septal closure in 1, and tricuspid valvuloplasty in 1 without PS/PA. Mean follow-up period was 19.4 years. Long-term survival rates were assessed with respect to the presence or the absence of preoperative PS/PA and specifically in relation with the magnitude of pre- and postoperative tricuspid regurgitation (TR).
Results
There has been no long-term mortality in the ccTGA patients without PS/PA. Twenty-year survival rate after conventional Rastelli was 71 %. Overall 20-year freedom from more than mild TR or tricuspid valve replacement was 44 %. The development of postoperative more than mild TR was significantly linked with pre-repair right ventricular enlargement (p = 0.019), but not with the magnitude of pre-repair TR (p = 0.85).
Conclusion
Long-term outcomes of physiologic repair for ccTGA were equivalent to those of reported anatomic repair performed in several centers during the same era. Notably, significant TR was observed in more than half of physiologically repaired patients over the 20 years after repair. The degree of pre-repair TR cannot predict the long-term function of tricuspid valve after physiologic repair.
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References
Van Praagh R. What is congenitally corrected transposition? N Engl J Med. 1970;282:1097–8.
Hraska V, Duncan BW, Mayer JE Jr, Freed M, del Nido PJ, Jonas RA. Long-term outcome of surgically treated patients with corrected transposition of the great arteries. J Thorac Cardiovasc Surg. 2005;129:182–91.
Yeh T Jr, Connelly MS, Coles JG, Webb GD, McLaughlin PR, Freedom RM, et al. Atrioventricular discordance: results of repair in 127 patients. J Thorac Cardiovasc Surg. 1999;117:1190–203.
Termignon JL, Leca F, Vouhe PR, Vernant F, Bical OM, Lecompte Y, et al. “Classic” repair of congenitally corrected transposition and ventricular septal defect. Ann Thorac Surg. 1996;62:199–206.
Ilbawi MN, DeLeon SY, Backer CL, Duffy CE, Muster AJ, Zales VR, et al. An alternative approach to the surgical management of physiologically corrected transposition with ventricular septal defect and pulmonary stenosis or atresia. J Thorac Cardiovasc Surg. 1990;100:410–5.
Alghamdi AA, McCrindle BW, Van Arsdell GS. Physiologic versus anatomic repair of congenitally corrected transposition of the great arteries: meta-analysis of individual patient data. Ann Thorac Surg. 2006;81:1529–35.
Gaies MG, Goldberg CS, Ohye RG, Devaney EJ, Hirsch JC, Bove EL. Early and intermediate outcome after anatomic repair of congenitally corrected transposition of the great arteries. Ann Thorac Surg. 2009;88:1952–60.
Mavroudis C, Backer CL. Physiologic versus anatomic repair of congenitally corrected transposition of the great arteries. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2003;6:16–26.
Hoashi T, Kagisaki K, Miyazaki A, Kurosaki K, Shiraishi I, Yagihara T, et al. Anatomic repair for corrected transposition with left ventricular outflow tract obstruction. Ann Thorac Surg. 2013;96:611–20.
Bautista-Hernandez V, Myers PO, Cecchin F, Marx GR, Del Nido PJ. Late left ventricular dysfunction after anatomic repair of congenitally corrected transposition of the great arteries. J Thorac Cardiovasc Surg. 2014;148:254–8.
Murtuza B, Barron DJ, Stumper O, Stickley J, Eaton D, Jones TJ, et al. Anatomic repair for congenitally corrected transposition of the great arteries: a single-institution 19-year experience. J Thorac Cardiovasc Surg. 2011;142(1348–57):e1.
Graham TP Jr, Bernard YD, Mellen BG, Celermajer D, Baumgartner H, Cetta F, et al. Long-term outcome in congenitally corrected transposition of the great arteries: a multi-institutional study. J Am Coll Cardiol. 2000;36:255–61.
Hsu KH, Chang CI, Huang SC, Chen YS, Chiu IS. 17-Year experience in surgical management of congenitally corrected transposition of the great arteries: a single-centre’s experience. Eur J Cardiothorac Surg. 2016;49:522–7.
Shin’oka T, Kurosawa H, Imai Y, Aoki M, Ishiyama M, Sakamoto T, et al. Outcomes of definitive surgical repair for congenitally corrected transposition of the great arteries or double outlet right ventricle with discordant atrioventricular connections: risk analyses in 189 patients. J Thorac Cardiovasc Surg. 2007;133:1318–28 (28 e1–4).
Kollars CA, Gelehrter S, Bove EL, Ensing G. Effects of morphologic left ventricular pressure on right ventricular geometry and tricuspid valve regurgitation in patients with congenitally corrected transposition of the great arteries. Am J Cardiol. 2010;105:735–9.
Hiramatsu T. The long-term results of double switch operation and functional repair for congenitally corrected transposition of the great arteries. Gen Thorac Cardiovasc Surg. 2015;63:485–6.
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Adachi, O., Masaki, N., Kawatsu, S. et al. Long-term results after physiologic repair for congenitally corrected transposition of the great arteries. Gen Thorac Cardiovasc Surg 64, 715–721 (2016). https://doi.org/10.1007/s11748-016-0689-1
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DOI: https://doi.org/10.1007/s11748-016-0689-1