Midterm results of anatomic repair in a subgroup of corrected transposition.
BACKGROUND
Anatomic repair has become the preferred option in the subgroup of patients with congenitally corrected transposition of the great arteries with ventricular septal defect and pulmonary obstruction. We report our 14-year experience with this approach.


METHODS
From April 2001 to February 2014, 22 patients with congenitally corrected transposition with ventricular septal defect and pulmonary obstruction underwent anatomic repair. Nineteen patients had a modified Senning-Rastelli procedure, 2 had a Mustard-Rastelli procedure, and one had a hemi-Mustard-Glenn-Rastelli procedure. The mean age was 10.9 years, and 8 (36.4%) patients were male.


RESULTS
There were 2 early deaths from sepsis and ventricular failure at 18 and 81 days postoperatively, and 3 late deaths from ventricular failure at 4, 33, and 113 months postoperatively. Left ventricular failure with mitral valve regurgitation was present in 3 of the 5 patients who died. Among the survivors, 3 underwent 4 transcatheter interventions for right ventricular outflow tract obstruction and 3 underwent 4 reoperations for atrial pathway obstruction, left and right ventricular outflow tract obstruction, or residual shunt. At a median follow-up of 64 months (range 14-167 months), 15 of 17 survivors were in functional class I. One patient had severe mitral valve regurgitation and was awaiting valve replacement. Another patient had right ventricular outflow conduit obstruction and was scheduled for reoperation.


CONCLUSIONS
Results of atrial switch-Rastelli procedures in this subgroup of patients with corrected transposition are satisfactory but still imperfect. Mitral regurgitation might predict a poor outcome. Long-term follow-up is necessary.
Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Teerapong
T
Tocharoenchok
Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Somchai
S
Sriyoschati
Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Punnarerk
P
Tongcharoen
Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Kriangkrai
K
Tantiwongkosri
Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand subtaweesin@gmail.com.
Thaworn
T
Subtaweesin
D000015:Abnormalities, Multiple; D000293:Adolescent; D000328:Adult; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D000080041:Congenitally Corrected Transposition of the Great Arteries; D018572:Disease-Free Survival; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000175:diagnosis / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007018:Hypopituitarism; D008297:Male; D008850:Microphthalmos; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D018633:Pulmonary Atresia / Q000175:diagnosis / Q000601:surgery; D011666:Pulmonary Valve Stenosis / Q000175:diagnosis / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
Cardiac surgical procedures; Heart septal defects; Pulmonary atresia; Pulmonary valve stenosis; Transposition of great vessels; Treatment outcome; ventricular