Comparative Long-Term Outcomes of Anatomical and Physiological Repair for Corrected Transposition

Area of Science:

• Cardiology
• Pediatric Cardiac Surgery
• Congenital Heart Disease

Background:

• Congenitally corrected transposition of the great arteries (ccTGA) presents complex surgical challenges.
• The optimal surgical strategy for ccTGA remains a subject of debate, impacting long-term patient outcomes.

Purpose of the Study:

• To compare the long-term outcomes of different surgical strategies for ccTGA.
• To identify the preferred management approach for patients with ccTGA undergoing biventricular repair.

Main Methods:

• Retrospective review of 107 patients with ccTGA undergoing biventricular repair (1978-2023).
• Patients categorized into four groups: atrial switch with arterial switch (AR-A), atrial switch with Rastelli (AR-R), physiological repair with Rastelli (PR-R), and physiological repair with native pulmonary valve (PR-N).
• Primary endpoint: all-cause mortality; Secondary endpoints: reoperation, heart failure, arrhythmia, pacemaker implantation.

Main Results:

• Twenty-year survival was comparable between anatomical and physiological repairs (79% vs 82%).
• The AR-A group demonstrated superior functional outcomes, including preserved systemic ventricular function and higher maximum oxygen uptake.
• Rastelli-type repairs were associated with lower reoperation-free survival and increased incidence of heart failure.

Conclusions:

• While survival is similar across strategies, atrial switch with arterial switch (AR-A) repair provides the most favorable long-term functional results for ccTGA.
• AR-A should be considered the preferred surgical strategy when anatomically feasible.
• Refinements in Rastelli-type repair techniques are needed to mitigate risks of reoperation and heart failure.