Faculty Collaboration Database

Functional outcome of anatomic correction of corrected transposition of the great arteries. Eur J Cardiothorac Surg 2011 Nov;40(5):1227-34

Date

03/15/2011

Pubmed ID

21397514

DOI

10.1016/j.ejcts.2011.01.077

Scopus ID

2-s2.0-80053970836 (requires institutional sign-in at Scopus site)   34 Citations

Abstract

OBJECTIVE: Anatomic correction of corrected transposition of the great arteries, utilizing the morphologic left ventricle as a systemic pumping chamber, is considered the preferred method. The purpose of the study was to analyze the intermediate functional outcome following anatomical correction.

METHODS: Between 1997 and 6/2010, 23 patients with corrected transposition of the great arteries and associated lesions underwent anatomical correction. Seventeen (74%) and six patients (26%) had situs solitus {S,L,L} and situs invs {I,D,D}, respectively. Fifteen patients (65%) had undergone 18 palliations before the corrective operation. The median age at palliation was 0.23 years, with a range of 0.016-8.4 years. A corrective, modified Senning-arterial switch procedure was performed in nine patients, 13 patients underwent a modified Senning-Rastelli procedure, and in one patient a combination of modified Senning and aortic translocation (Bex/Nikaidoh) was used. The median age at the corrective operation was 2 years (from 0.3 to 15.7 years).

RESULTS: There was no mortality or heart transplant within the mean follow-up of 3.4 years. Freedom from reintervention was 77% at 5 years. There were no signs of obstruction of the systemic and pulmonary venous tunnels. The function of both ventricles was normal in all patients, even in the four patients who required retraining of the left ventricle. Mild aortic regurgitation was noticed in three patients. Preoperatively detected significant tricuspid regurgitation either disappeared or became trivial after the operation in all the six patients. All patients except two are in sinus rhythm; one patient is pacemaker-dependent preoperatively and one is pacemaker-dependent postoperatively. There were no clinically apparent neurological problems. All patients, but one, are in the New York Heart Association (NYHA) class I.

CONCLUSIONS: Anatomic correction of corrected transposition of the great arteries can be performed in selected patients without mortality and with acceptable morbidity. The mid-term functional outcome is excellent, resulting in normal ventricular function, even in retrained left ventricles, and minimal incidence of complete heart block. The long-term function of the aortic valve, intraventricular tunnels, conduits, and ventricles requires close surveillance.

Author List

Hraška V, Mattes A, Haun C, Blaschczok HC, Photiadis J, Murin P, Zartner P, Asfour B

Author

Viktor Hraska MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Aortic Valve Insufficiency
Cardiopulmonary Bypass
Child
Child, Preschool
Disease-Free Survival
Female
Heart Defects, Congenital
Humans
Infant
Male
Reoperation
Retrospective Studies
Transposition of Great Vessels
Treatment Outcome
Ventricular Function
Ventricular Outflow Obstruction