Surgical Outcomes for Congenitally Corrected Transposition of the Great Arteries with Two Ventricles

Objectives: The optimal surgical strategy for congenitally corrected transposition of the great arteries (ccTGA) with two ventricles is still controversial. The aim of our study is to present our outcomes in patients with ccTGA and two ventricles who received different surgical strategies.

Methods: Since 1993, we have operated 27 patients with ccTGA and two ventricles. Median age of operation was 4.3 years (range: 12 days–42.8 years). We divided the cohort into five groups. Group I: only main pulmonal artery banding (PAB); group II: only pacemaker implantation; group III: anatomic repair; group IV: conventional repair with keeping the right ventricle as a systemic ventricle; and group V: univentricular palliation. In group I, main PAB was performed in six patients; three of them needed simultaneous pacemaker implantation. In group II, two patients received only pacemaker. In group III, seven patients underwent anatomic repair. They received initially main PAB or arterial pulmonary shunt and then underwent combined atrial and arterial switch operation (Senning + Jatane [n = 3]; Senning + Rastelli [n = 4]). One patient who had hypoplastic aortic arch underwent initially bilateral PAB and ductus stenting and is still awaiting for anatomic repair. In group IV, 10 patients received conventional repair with VSD closure (n = 6) or tricuspid valvuloplasty (n = 7) or in combination. One patient underwent univentricular palliation due to ccTGA, pulmonary atresia and superior–inferior ventricle morphology.

Results: Early mortality was 3.7% (n = 1, group IV). The patient died due to hypoxic brain damage. Median follow-up was 8.6 years (range: 6 days–25.7 years). Long-term mortality was not observed. During follow-up, nine patients (34.6%) needed a reoperation and 13 patients (50%) required a reintervention (group I: two reinterventions with ablation due to arrythmias; group III: five reoperations and five reinterventions because of buffle or conduit stenosis; group IV: four reoperations and five interventions due to tricuspid valve regurgitation and rhythm problems; group V: one patient with univentricular palliation). Two patients (in group III and IV) required cardiac transplantation. The functional classification of patients was NYHA I (n = 17, 65%) and NYHA II (n = 9, 35%).

Conclusion: Our experience emphasizes the complexity of the disease and the importance of individual decision making. Anatomic repair can be performed successfully in selected patients but with high rates of reoperation and reintervention.

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