Long-term outcome and cardiac function after anatomic repair of congenitally corrected transposition

TL;DR

This study examines long-term outcomes of heart function and survival in patients with a rare heart condition after surgical repair, finding acceptable results but notable late complications.

Contribution

The paper provides long-term follow-up data on cardiac outcomes after anatomic repair of congenitally corrected transposition of the great arteries.

Findings

Mortality rates at 10 and 20 years were 86% and 71%, with no significant difference between surgical groups.

Late complications like heart failure and reoperation were relatively common, especially in the Rastelli–Senning/Mustard group.

Aortic regurgitation occurred in some patients, more frequently after the double switch operation.

Abstract

There is limited information on long-term outcomes and trajectories of ventricular and valvular functions in patients with congenitally corrected transposition of the great arteries after anatomic repair according to the operative strategy with a median follow-up period of more than 10 years.

Twenty-nine patients who underwent anatomic repair in Okayama University Hospital between January 1994 and December 2020 were reviewed. Outcomes were compared between patients who underwent a double switch operation (DS group) and patients with an atrial switch with a Rastelli operation (Rastelli–Senning/Mustard group).

Fifteen (52%) were in the DS group and 14 (48%) were in the Rastelli–Senning/Mustard group. The median follow-up period after anatomic repair was 12.7 (interquartile range 4.2–18.8) years. There were 3 (10%) early deaths and 3 (10%) late deaths. Survival rates for the entire cohort at 10 and 20 years were 86% and 71%, respectively, and were not different between the 2 groups. Using competing risk analysis, risks of heart failure, cardiac rhythm device implantation and atrial arrhythmia showed no significant differences between the 2 groups, whereas risk of reoperation was higher in the Rastelli–Senning/Mustard group than that in the DS group. Four patients after a DS operation and 1 patient after a Rastelli technique developed more than moderate aortic regurgitation.

During a median follow-up period of more than 10 years, mortality rate and ventricular and valvular functions after anatomic repair were acceptable, though the incidences of late complications were relatively high, especially in the Rastelli–Senning/Mustard group.

Anatomic repair has been widely performed for congenitally corrected transposition of the great arteries (ccTGA) and it is expected to enable maintenance of systemic ventricular and valvular functions.

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