Long-Term Outcomes of Definitive Surgical Repair for Congenitally Corrected Transposition of the Great Arteries

Abstract

Objective: To determine optimal treatment strategies by examining the long-term outcomes and challenges of different surgical procedures for congenitally corrected transposition of the great arteries （ccTGA）.
Subjects: Clinical records of 71 patients with ccTGA, who underwent definitive surgery （physiologic: 45; anatomic: 14; and Fontan-type: 12） in our hospital from November 1977 to October 2013, were retrospectively reviewed.
Results: During the follow-up period, there were 7 deaths in 71 patients. Late mortality occurred in 6 patients （in 5 of which TVR was performed） after physiologic repair and early mortality occurred in 1 patient after anatomic repair. While there were no significant differences in the postoperative survival and reoperation rates between the groups, those who underwent physiologic repair with TVR showed a low postoperative survival rate （20-year survival rate with and without TVR: 58.6 and 96.3%, respectively）. After anatomic repair, those treated with Jatene-type DS showed the most favorable prognosis, not requiring reoperation or PMI. In contrast, those treated with Rastelli-type DS frequently needed reoperation and PMI. All Fontan group patients survived, although complications （PLE and hepatic tumor） occurred during the long-term follow-up period.
Conclusion: When treating ccTGA, it may be important to develop treatment strategies, according to individual pathological conditions, and stratifying risks.