Functional Outcome of Anatomic Correction of Corrected Transposition of the Great Arteries

Objectives: Anatomic correction of ccTGA, utilizing the morphologic left ventricle as a systemic pumping chamber, is the preferred method. The purpose of the study was to analyze functional outcome after anatomical correction.

Methods: Between 1997 and 4/2014 44 pts with ccTGA and associated lesions underwent anatomical correction. Double switch procedure was performed in 24 pts, 19 pts underwent Senning/Rastelli operation and in one patient combination of Senning and aortic translocation was used. Median age at operation was 3.1 years (from 0.2 to 15.7 years).

Results: Survival benefit and freedom from reoperation was 97% and 76% at 10 years of follow up respectively. Three pts needed reoperation of the right ventricular outflow tract, one had obstruction in Senning pathway and two others had pacemaker surgery. Function of systemic ventricle is normal in all pts, but one with moderately depressed function and aortic regurgitation. Neoaortic mild to moderate regurgitation was noticed in 4 pts. Preoperatively detected tricuspid regurgitation in 16 pts disappeared after operation in all pts. All patients are in SR, but 10 (23%), 5 before and 5 after operation, have required implantation of a pacemaker. There were no clinically apparent neurological problems. 52% of pts are without any medication.

Conclusions: Anatomical correction of ccTGA is a safe procedure providing excellent mid-term functional outcome. Neoaortic regurgitation is typically seen in double switch group. Senning/Rastelli group suffers from conduit problems. Heart block is imminent for whole group. The long-term benefits of this approach must be established by careful follow-up of these patients.