Surgery for transposition of the great arteries, ventricular septal defect and left ventricular outflow tract obstruction: European Congenital Heart Surgeons Association multicentre study.
OBJECTIVE
Optimal surgical management for patients with transposition of the great arteries (TGA), ventricular septal defect (VSD) and left ventricular outflow obstruction (LVOTO) remains controversial. Although the Rastelli operation has been the most widely performed surgical procedure during the past decades, several studies have shown its suboptimal long-term prognosis. Other operations have been developed to improve results. This study was performed to compare the outcomes of the different surgical approaches for patients with TGA, VSD and LVOTO, as well as to determine risk factors for mortality and re-intervention.


METHODS
Records from 146 patients undergoing surgery from 1980 to 2008 from eight European hospitals were reviewed. Median age at operation was 21.5 months (range 0.2-165.1 months), and median weight was 10.0 kg (range 2.0-41.0 kg). Surgical procedures involved were the Rastelli procedure (82), arterial (24) and atrial (5) switch operation with relief of LVOTO, Réparation à l'Etage ventriculaire (REV) procedure (7) and the Metras modification (24), as well as the Nikaidoh procedure (4).


RESULTS
The overall survival was 88%, 88% and 58% at 1, 10 and 20 years, respectively. The overall event-free survival was 80%, 45% and 26% at 1, 10 and 20 years, respectively. The REV procedure and the Metras modification were found to have the best long-term results in both survival and event-free survival rates. Multivariate analysis revealed year of operation, non-commitment of the VSD and prolonged cardiopulmonary bypass (CPB) time as risk factors for mortality while age at surgery, year of operation and type of corrective surgery were risk factors for re-intervention.


CONCLUSIONS
Different surgical approaches have been developed for patients with TGA, VSD and LVOTO. The REV procedure and the Metras modification were observed to have favourable long-term results in survival and event-free survival rates. Aortic translocation techniques such as the Nikaidoh procedure seem promising, but further studies will be needed to confirm this in the long term.
Hazekamp
Mark Gerard
MG
Leids Universitair Medisch Centrum, Leiden, The Netherlands. m.g.hazekamp@lumc.nl
Gomez
Alejandro Adsuar
AA
Koolbergen
David R
DR
Hraska
Viktor
V
Metras
Dominique R
DR
Mattila
Ikka Pellervo
IP
Daenen
Willem
W
Berggren
Hakan E
HE
Rubay
Jean-Etienne
JE
Stellin
Giovanni
G
D000015:Abnormalities, Multiple / Q000601:surgery*; D000293:Adolescent; D001807:Blood Vessel Prosthesis; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D004812:Epidemiologic Methods; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006345:Heart Septal Defects, Ventricular / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D012086:Reoperation / Q000379:methods; D014188:Transposition of Great Vessels / Q000601:surgery; D014694:Ventricular Outflow Obstruction / Q000601:surgery