Repair of Complex Transposition of Great Arteries: Up to 30 Years of Follow-Up

Abstract Background To characterize treatment of transposition of great arteries with ventricular septal defect and left ventricular outflow tract obstruction (TGA-VSD-LVOTO) in Germany, and to analyze late outcomes. Methods German National Quality Assurance for Congenital Heart Disease data were searched for TGA-VSD-LVOTO. A total of n=139 patients were treated at 15 institutions between 1968 and 2016 Risk factor analyses were performed for primary endpoints death and reoperation/reintervention. Results Follow-up was 88% complete, mean/median follow-up-times were 16±7/15 years (1-48 years), cumulative follow-up comprised 1739 patient-years. Atrial switches were performed in 15%, Rastelli in 48%, Nikaidoh in 9%, reparation a l'etage ventriculair (REV) in 8%, and arterial switch in 20%. Actuarial survival at 30 years was 86% (83-90%), with no difference between repairs. Freedom from primary reoperation was 17% (12-21%) at 30 years. Freedom from reoperation for LVOTO at 30 years was 74% (70-78%). Recurrent LVOTO was found in 9%, with risk factor diffuse subvalvular LVOTO (OR 9.8, p 0.04). Late freedom from first reoperations other than right-ventricle-to-pulmonary-artery-conduit was 60% (59-61%), with predictors multiple VSD (HR 6, p=0.03) and Rastelli (HR 12, p=0.03). Absolute reoperation rates were lowest for REV procedure (16% at a mean of 12 years). Conclusions Long-term survival is good without detectable differences between operations. Since the early 2000s increasing use of Nikaidoh and REV-procedures was obvious, with REV performing particularly well. Surgery-specific and unspecific reoperations are most common after Rastelli.