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Corrected transposition and ventricular septal defect. Surgical experience

C Marcelletti, J D Maloney, D G Ritter

    Annals of Surgery
    |June 1, 1980
    PubMed
    Summary
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    Surgical repair of corrected transposition of the great arteries (CTGA) with ventricular septal defect (VSD) has improved significantly. New techniques for pulmonary outflow tract obstruction (POTO) reduced mortality and heart block incidence.

    Area of Science:

    • Cardiovascular Surgery
    • Pediatric Cardiology
    • Congenital Heart Disease

    Background:

    • Corrected transposition of the great arteries (CTGA) with ventricular septal defect (VSD) presents complex surgical challenges.
    • Historically, high mortality rates and complications like heart block have been associated with intracardiac repair.

    Purpose of the Study:

    • To review a 21-year institutional experience with intracardiac repair of CTGA associated with VSD.
    • To evaluate the impact of surgical techniques on hospital mortality, heart block, and relief of pulmonary outflow tract obstruction (POTO).

    Main Methods:

    • Retrospective review of 53 intracardiac repair operations for CTGA with VSD over 21 years.
    • Analysis of surgical techniques, including the use of systemic ventriculotomy and a novel approach for POTO using an extracardiac conduit.

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  • Evaluation of intraoperative mapping of the conduction bundle and its association with heart block.

    • Main Results:

    • Hospital mortality decreased from 50% pre-1972 to 18% post-1972 (p < 0.02).
    • Mortality was lower without systemic ventriculotomy (19% vs. 60%, p < 0.01).
    • A new technique for POTO reduced complete heart block from 67% to 28% (p < 0.05) and inadequate POTO relief from 50% to 8% (p < 0.01).
    • Patients requiring atrioventricular (AV) valve repair had higher operative mortality (50% vs. 20%, p < 0.05).
    • Operative mortality was 5% for patients with VSD and POTO achieving good relief.

    Conclusions:

    • Significant progress has been made in the surgical repair of CTGA with VSD.
    • Refined surgical techniques, particularly for POTO, have demonstrably improved outcomes.
    • Further advancements are needed to enhance surgical results for this complex congenital heart defect.