HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Rajesh Sharma Sachin Talwar Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Sharma, R. Articles by Kothari, S. S. Search for Related Content PubMed Articles by Sharma, R. Articles by Kothari, S. S. Related Collections Cardiac - other Congenital - acyanotic Congenital - cyanotic

J Thorac Cardiovasc Surg 2009;137:404-412
© 2009 The American Association for Thoracic Surgery

Congenital Heart Disease

Anatomic repair for congenitally corrected transposition of the great arteries

^a Narayana Hrudayalaya Institute of Cardiac Sciences, Bangalore, India
^b Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, India
^c Fortis Hospital, New Delhi, India

Received for publication March 30, 2008; revisions received August 2, 2008; accepted for publication September 19, 2008.

^_* Address for reprints: Rajesh Sharma, Director of Pediatric Cardiac Surgery, Escorts Heart Institute and Research Centre, New Delhi-110025, India. (Email: rsharmacvs{at}hotmail.com).

Objective: Anatomic repair is being actively evaluated as the preferred option for congenitally corrected transposition of the great arteries. We present our 13-year experience with this approach.

Methods: Between May 1994 and September 2007, 68 patients with congenitally corrected transposition of the great arteries underwent anatomic repair. Thirty-one patients (group 1, mean age of 94.8 ± 42.3 months) underwent a combined Rastelli and atrial switch operation. Thirty-seven patients (group 2, mean age of 36.1 ± 46.9 months) underwent an arterial switch operation and atrial rerouting. Eight patients in group 2 had an intact ventricular septum.

Results: Group 1 had 5 early deaths (17%) but no late deaths. Three patients underwent conduit revision at a mean follow-up of 62 months. Group 2 had 5 early deaths (13.5%). There were 4 late reoperations (2 pulmonary baffle revisions, 1 mitral valve replacement, and 1 permanent pacemaker implantation) and 4 late deaths (1 secondary to progressive left ventricular dysfunction, 2 secondary to uncontrolled atrial tachyarrhythmia, and 1 secondary to pulmonary hypertension and right ventricular failure). In group 2, 4 patients have a left ventricular ejection fraction less than 40%, 5 patients have moderate aortic incompetence, 5 patients have symptomatic tricuspid incompetence, 1 patient has tricuspid stenosis, 1 patient has superior cava obstruction, and 3 patients are receiving antiarrhythmic therapy.

Conclusion: The occurrence of left ventricular dysfunction indicate that anatomic repair in the arterial switch group is still fraught with imperfections. The Rastelli group required conduit revisions but has otherwise performed well.