Long-term outcome of surgically treated patients with corrected transposition of the great arteries.
OBJECTIVE
The purpose of the study was to examine long-term outcome after traditional surgical treatment of corrected transposition of the great arteries to provide a basis for comparison with new procedures, such as the double-switch or Senning-Rastelli procedures.


METHODS
Patient- and procedure-related variables in 123 patients with corrected transposition and 2 functional ventricles operated on between 1963 and 1996 were analyzed. Patients with intracardiac procedures underwent either a traditional 2-ventricle repair or a Fontan procedure.


RESULTS
The 1-, 5-, 10-, and 15-year survivals after the operation were 84%, 75%, 68%, and 61%, respectively. Patients requiring tricuspid valve replacement (27 patients) at any time during follow-up had a significantly worse outcome ( P < .001; hazard ratio, 4.4), whereas the best outcome was seen in patients undergoing the Fontan procedure (17 patients, 0 deaths). Right ventricular end-diastolic pressure of greater than 17 mm Hg before the operation ( P < .0001), complete heart block after the operation ( P = .001), subvalvular pulmonary stenosis ( P = .013), Ebstein malformation of the tricuspid valve ( P = .025), and preoperative systemic (right) ventricular dysfunction ( P = .041) were identified as risk factors for death at any time by means of univariate analysis. Ebstein malformation of the tricuspid valve ( P = .036; hazard ratio, 1.5) was identified as a risk factor for death by multivariate analysis.


CONCLUSIONS
The long-term outcome of patients with corrected transposition after a classic surgical approach is unsatisfactory. The poorest outcome was seen in patients who required tricuspid valve replacement either at their initial operation or later during follow-up. Alternative surgical approaches, such as the double-switch, Senning-Rastelli, or Fontan procedures, are likely to have better long-term results, especially in the highest risk groups.
Hraska
Viktor
V
Department of Pediatric Cardiac Surgery, University Hospital Hamburg-Eppendorf, Germany.
Duncan
Brian W
BW
Mayer
John E
JE
Freed
Michael
M
del Nido
Pedro J
PJ
Jonas
Richard A
RA
D000704:Analysis of Variance; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002423:Cause of Death; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality; D011237:Predictive Value of Tests; D011336:Probability; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*