Anatomic repair for corrected transposition with left ventricular outflow tract obstruction
Takaya Hoashi1, Koji Kagisaki, Aya Miyazaki
1Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan. thoashi@surg1.med.osaka-u.ac.jp
The Annals of Thoracic Surgery
|June 8, 2013
Summary
Anatomic repair for congenitally corrected transposition of great arteries (ccTGA) with outflow obstruction offers excellent long-term outcomes. For complex cases, the Damus-Kaye-Stansel (DKS) anastomosis effectively prevents future complications.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Cardiac Anatomy
Background:
- Investigating long-term results of anatomic repair for congenitally corrected transposition of great arteries (ccTGA).
- Focusing on ccTGA variants with left ventricular outflow tract obstruction (LVOTO) and ventricular septal defect (VSD).
Purpose of the Study:
- To evaluate the effectiveness of anatomic repair in patients with ccTGA, LVOTO, and VSD.
- To assess long-term survival and complication rates following surgical intervention.
Main Methods:
- Retrospective analysis of 47 patients (1987-2011) undergoing anatomic repair for ccTGA with LVOTO and VSD.
- Utilized Mustard or Senning atrial switch procedures; DKS anastomosis added in select cases.
- Mean follow-up of 11.6 years.
Main Results:
- Overall 20-year survival rate of 70.2%.
- No mortality in the last 21 consecutive patients since 1997.
- No reoperations for systemic ventricular outflow tract obstruction; low incidence of surgical heart block (2.1%).
- No moderate or greater aortic or neo-aortic regurgitation.
Conclusions:
- Anatomic repair yields excellent recent outcomes for ccTGA with LVOTO and VSD.
- DKS anastomosis is effective in preventing postoperative obstruction and heart block in patients with pulmonary stenosis and restrictive VSD.
Keywords:
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