Anatomic Versus Physiologic Repair in Congenitally Corrected Transposition: A Propensity-Matched European Multicentre Study

Abstract

Objectives: Patients with congenitally corrected transposition of the great arteries (ccTGA) may undergo physiologic repair, leaving the right ventricle systemic, or anatomic repair, correcting the double discordance. We compared both strategies in an international study using propensity-score matching. Methods: Patients from 12 European centres, aged <18 years, who underwent either physiologic or anatomic repair between 1990 and 2010 were included (n = 266). Patients were matched by optimal pair matching on ventricular septal defect, subpulmonary left ventricular outflow tract obstruction, ≥mild systemic tricuspid valve regurgitation, age, and gender, resulting in a 1:1 matched cohort of 162 patients. The resulting groups were compared for long-term survival, reoperations, and function of the systemic ventricle and atrioventricular valve. Results: Transplant-free survival at 10 and 15 years was 87 ± 4%, 95% confidence interval (CI) [79%-95%] and 80 ± 6% [68%-93%] for the physiologic group and 85 ± 5% [78%-96%] and 85 ± 5% [78%-96%] for the anatomic group (P = .568). Freedom from cardiac reoperation at 10 and 15 years was 73 ± 6% [62%-85%] and 56 ± 8% [41%-75%] for the physiologic group and 61 ± 8% [47%-76%] and 36 ± 9% [26%-62%] for the anatomic group (P = .279). Tricuspid valve regurgitation at final follow-up was present in 57% (27/47) vs 17% (12/72), respectively (P < .001). Conclusions: Long-term survival and reoperation rates are similar in comparable patients following physiologic and anatomic repair of ccTGA in childhood. Tricuspid valve function may deteriorate when left in the systemic position following physiologic repair. In contrast, patients with tricuspid regurgitation may benefit from anatomic repair, with improved function in the subpulmonary position.