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Published on: July 18, 2014
Congenitally Corrected Transposition Cardiac Surgery: Society of Thoracic Surgeons Database Analysis
Joshua D Chew1, Kevin D Hill2, Jonathan H Soslow1
1Division of Pediatric Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
Insights
Congenitally corrected transposition of the great arteries (ccTGA) management varies, with anatomic repair most common. Atrial switch plus Rastelli operations showed higher mortality and complications in this large multicenter study.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Congenitally corrected transposition of the great arteries (ccTGA) presents diverse management challenges.
- Anatomic repair has emerged as a significant surgical option for ccTGA.
- Multicenter data on contemporary surgical practices for ccTGA are limited.
Purpose of the Study:
- To analyze the distribution of surgical procedures for ccTGA.
- To define contemporary outcomes of ccTGA management strategies.
- To assess surgical outcomes in a large multicenter cohort.
Main Methods:
- Utilized The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010-2019).
- Categorized index cardiovascular operations into mutually exclusive management strategy groups.
- Employed Pearson χ² and Kruskal-Wallis tests for statistical analysis.
Main Results:
- 985 index operations were performed across 101 centers; anatomic repair was the most frequent approach.
- Atrial switch plus Rastelli operations exhibited the highest operative mortality (8.4%) and major complication rates (38.2%).
- Heart transplant survivors experienced the longest postoperative length of stay (18 days).
Conclusions:
- ccTGA patients represent a complex surgical cohort with varied interventions.
- Significant operative mortality and morbidity persist despite diverse management strategies.
- Further research is needed to optimize ccTGA treatment outcomes.
Background:
Congenitally corrected transposition of the great arteries (ccTGA) has many management strategies, with the emergence of anatomic repair increasing the available surgical options. Contemporary surgical practices have not been described in multicenter analyses. This study describes the distribution of heart surgery in patients with ccTGA and defines contemporary outcomes in a large multicenter cohort.
Methods:
Index cardiovascular operations in patients with primary or fundamental diagnosis of ccTGA were identified in The Society of Thoracic Surgeons Congenital Heart Surgery Database from 2010 to 2019. Operations of interest were combined into mutually exclusive groups designating overall ccTGA management strategies. Outcomes were defined with standard Society of Thoracic Surgeons Congenital Heart Surgery Database definitions. Pearson χ2 and Kruskal-Wallis tests were used for statistical comparisons.
Results:
One hundred one centers performed 985 index operations, with anatomic repair the most common approach. Twenty-six centers performed more than 10 operations. Atrial switch plus Rastelli operations had the highest rate of operative mortality (8.4%) and major complications (38.2%). Heart transplant operations had the longest postoperative length of stay among survivors (18 days [interquartile range, 13.5-26]).
Conclusions:
Patients with ccTGA remain a challenging cohort, with significant diversity in the operations used and a substantial burden of operative mortality and morbidity.
