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Anatomic Versus Physiologic Repair in Congenitally Corrected Transposition: A Propensity-Matched European Multicentre

Jelena Pabst Von Ohain1,2,3, Leonie Arnold4, Kirolos A Jacob5

  • 1Division of Congenital Heart Surgery, University Hospital Grosshadern, Ludwig-Maximilians University, 81377 Munich, Germany.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|April 14, 2026
PubMed
Summary

Long-term survival and reoperation rates are similar for both physiologic and anatomic repair of congenitally corrected transposition of the great arteries (ccTGA). However, anatomic repair may offer better tricuspid valve function.

Keywords:
ccTGAdouble discordancepropensity-score matchingsystemic right ventriclesystemic tricuspid valve

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Area of Science:

  • Cardiology
  • Pediatric Cardiac Surgery
  • Congenital Heart Disease

Background:

  • Congenitally corrected transposition of the great arteries (ccTGA) presents complex surgical challenges.
  • Surgical options include physiologic repair (right ventricle systemic) and anatomic repair (correcting double discordance).

Purpose of the Study:

  • To compare long-term outcomes of physiologic versus anatomic repair in pediatric ccTGA patients.
  • To evaluate survival, reoperation rates, and ventricular/valvular function after both repair strategies.

Main Methods:

  • International study including 266 patients aged <18 years undergoing ccTGA repair (1990-2010).
  • Propensity-score matching created a 1:1 cohort of 162 patients.
  • Comparison focused on long-term survival, reoperations, systemic ventricle, and atrioventricular valve function.

Main Results:

  • No significant difference in transplant-free survival at 10 and 15 years between groups (p=0.568).
  • Similar freedom from cardiac reoperation rates at 10 and 15 years (p=0.279).
  • Significantly higher incidence of tricuspid valve regurgitation in the physiologic repair group (57% vs 17%, p<0.001).

Conclusions:

  • Physiologic and anatomic repairs demonstrate comparable long-term survival and reoperation rates in ccTGA.
  • Tricuspid valve function may decline when the valve is in the systemic position after physiologic repair.
  • Anatomic repair may improve tricuspid valve function when it is in the subpulmonary position.