AATS: Rate of reoperation has not changed during 30 years of surgery for transposition of the great arteries - Long-term results of 913 patients at a single center

Rate of reoperation has not changed during 30 years of surgery for transposition of the great arteries - Long-term results of 913 patients at a single center

Jürgen Hörer, Julie Cleuziou, Christian Schreiber, Zsolt Prodan, Manfred Vogt, Klaus Holper, Rüdiger Lange; German Heart Center Munich at the Technical University, Munich, Germany

Comment on this Abstract

Objective: The Mustard (MO) and the Senning operation (SO) were the treatment of choice for patients with transposition of the great arteries (TGA) with intact ventricular septum (IVS), or ventricular septal defect (VSD), until they were abandoned in favor of the arterial switch operation (ASO). The Rastelli operation (RO) is applied for patients with additional left ventricular outflow tract obstruction (LVOTO).
Methods: Data of hospital survivors after the MO (81), SO (314), ASO (479), and RO (39) were analyzed.
Results: Mean follow-up times were for the MO 22.6±8.1, SO 18.2±5.7, ASO 9.5±5.7, and RO 9.9±6.5 years, respectively. The best survival at 20 years was observed after the ASO (96.6±1.3%), followed by the SO (92.6±1.5%), MO (82.4±4.3%), and RO (57.5±15.1%). Patients with TGA+IVS showed better survival at 20 years (95.7±1.1%) compared to patients with TGA+VSD (88.0±2.7%), and TGA+VSD+LVOTO (72.8±8.4%). Among morphology, prior operations, age, and type of correction, VSD emerged as the only risk factor (HR=2.6, 95% CI=1.5-4.8, p=0.001), and ASO as the only protective factor (HR=0.3, 95% CI=0.1-0.7, p=0.004) for late death. The best freedom from reoperation at 20 years was observed after the SO (88.7±1.9%), followed by the ASO (75.0±6.4%), MO (70.6±5.4%), and RO (32.6±10.1%). Patients with TGA+IVS showed better freedom from reoperation at 20 years (87.2±1.9%) compared to patients with TGA+VSD (71.6±4.0%), and TGA+VSD+LVOTO (50.8±7.2%).
Conclusion: The change in surgical strategy from atrial to arterial switch led to improved long-term survival but not lower incidence of reoperations. Outcome in terms of survival and freedom from reoperation is determined by morphology. The results of the RO are not satisfactory.

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