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Original Articles: Pediatric Cardiac

Outcomes of Biventricular Repair for Congenitally Corrected Transposition of the Great Arteries

^a Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Korea
^b Xenotransplantation Research Center, Seoul National University Hospital, Seoul, Korea
^c Transplantation Research Institute, Medical Research Center, Seoul National University, Seoul, Korea
^d Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
^e Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
^f Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Bucheon, Korea

Accepted for publication August 25, 2009.

^_* Address correspondence to Dr Lee, Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, 28 Yongon-dong, Jongro-gu, Seoul, 110-744, Korea (Email: jrl{at}plaza.snu.ac.kr).

Background: This study was undertaken to evaluate long-term results of biventricular repairs for congenitally corrected transposition of the great arteries, and to analyze the risk factors that affect mortality and morbidity.

Methods: Between 1983 and 2009, 167 patients with congenitally corrected transposition of the great arteries underwent biventricular repairs. The physiologic repairs were performed in 123 patients, and anatomic repairs in 44. Average follow-up was 9.3 ± 6.6 years.

Results: Kaplan-Meier estimated survival was 83.3% ± 0.5% at 25 years in biventricular repair. In anatomic repair, left ventricular training and right ventricular dysfunction had negative impact on survival, but bidirectional cavopulmonary shunt had positive impact on survival. The reoperation-free ratio was 10.1% ± 7.8% at 22 years after physiologic repair, and 46.2% ± 12.4% at 15 years after anatomic repair (p = 0.885). Freedom from any arrhythmia was 49.6% ± 7.5% at 22 years after physiologic repair, and 60.8% ± 14.8% at 18 years after anatomic repair (p = 0.458). Freedom from systemic atrioventricular valve and ventricular dysfunction as well as tricuspid valve and right ventricular dysfunction was significantly higher in anatomic repair than in physiologic repair.

Conclusions: Long-term results of biventricular repair were satisfactory. Patients presenting with right ventricular dysfunction or need for left ventricular training represent a high-risk group of anatomic repair for which selection criteria are particularly important. Late functional outcomes of anatomic repair were excellent compared with physiologic repair. Anatomic repair is the procedure of choice for those patients if both ventricles are adequate or if surgical technique is modified with the help of additional a bidirectional cavopulmonary shunt.