Transposition of the Great Arteries With Intact Ventricular Septum and Left Ventricular Outflow Tract Obstruction: An Analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD)

Abstract

Purpose

Transposition of the great arteries with intact ventricular septum and left ventricular outflow tract obstruction (TGA + IVS + LVOTO) is a rare congenital cardiac malformation. This study aims to describe the operations performed for patients with TGA + IVS + LVOTO in the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) and review their short-term outcomes.

Methods

A total of 112 patients with the diagnosis of TGA + IVS + LVOTO in the STS-CHSD who underwent cardiac surgery between January 1999 and June 2021 were included. Patients’ characteristics, operative data, and postoperative outcomes were analyzed.

Results

A total of 120 index cardiac operations were performed. The most common operations were the arterial switch procedure (n = 33), Glenn/HemiFontan (n = 10), Fontan (n = 9), Rastelli with ventricular septal defect (VSD) creation (n = 6), Damus-Kaye-Stansel procedure (n = 5), heart transplant (n = 5), and atrial switch (n = 4). Concomitant repair of subvalvar aortic stenosis was coded in 7 of 33 patients undergoing the arterial switch operation. The overall operative mortality was 4.5% (5 deaths in 112 patients undergoing 120 index cardiac operations). The overall major complication rate was 19% (23 of 120 cases). Major complications occurred in 9 of 33 (27%) of the arterial switch operations. The most common complications were unplanned reoperation in 14 of 120 cases (12%) arrhythmias requiring pacemaker implantation in 5 of 120 (4.2%), and postoperative mechanical circulatory support in 4 of 120 (3.3%).

Conclusion

The diagnosis of TGA + IVS + LVOTO is rare in the STS-CHSD. The most common procedures performed for this disease were the arterial switch operation (often with concomitant repair of subvalvar aortic stenosis), Rastelli with VSD creation, and palliative functionally univentricular operations.

Keywords

left ventricular outflow tract intact ventricular septum‌transposition of the great arteries

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References

Freedom

Smallhorn

Trusler

. Transposition of the great arteries. In: Neonatal Heart Disease. Springer London; 1992:179-212. doi:https://doi.org/10.1007/978-1-4471-1814-5_14

Williams

McCrindle

Ashburn

Jonas

Mavroudis

Blackstone

. Outcomes of 829 neonates with complete transposition of the great arteries 12-17 years after repair. Eur J Cardiothorac Surg. 2003;24(1):1-10. doi:https://doi.org/10.1016/S1010-7940(03)00264-1

Vejlstrup

Sørensen

Mattsson

, et al. Long-term outcome of Mustard/Senning correction for transposition of the great arteries in Sweden and Denmark. Circulation. 2015;132(8):633-638. doi:https://doi.org/10.1161/CIRCULATIONAHA.114.010770

Hazekamp

Gomez

Koolbergen

, et al. Surgery for transposition of the great arteries, ventricular septal defect and left ventricular outflow tract obstruction: European Congenital Heart Surgeons Association multicentre study. Eur J Cardiothorac Surg. 2010;38(6):699-706. doi:https://doi.org/10.1016/j.ejcts.2010.03.030

Seese

Turbendian

Thibault

, et al. Utilization and outcomes of the Nikaidoh, Rastelli, and REV procedures: an analysis of the Society of Thoracic Surgeons Congenital Heart Surgery database. Ann Thorac Surg. 2022;114(3):800-808. doi:https://doi.org/10.1016/j.athoracsur.2021.06.019

Jatene

Fontes

Paulista

, et al. Successful anatomic correction of transposition of the great vessels. A preliminary report. Arq Bras Cardiol. 1975;28(4):461-464.

Patel

Herrmann

Bain

, et al. Risk factors for reoperation after arterial switch operation. World J Pediatr Congenit Hear Surg. 2021;12(4):463-470. doi:https://doi.org/10.1177/21501351211009768

Kalfa

Lambert

Baruteau

, et al. Arterial switch for transposition with left outflow tract obstruction: outcomes and risk analysis. Ann Thorac Surg. 2013;95(6):2097-2103. doi:https://doi.org/10.1016/j.athoracsur.2013.01.077

Raja

Kostolny

Oswal

, et al. Midterm follow-up of arterial switch operation for transposition of the great arteries with intact ventricular septum and left-ventricular outflow tract obstruction . Eur J Cardiothorac Surg. 2011;40(4):994-999. doi:https://doi.org/10.1016/j.ejcts.2011.01.039

10.

Sharma

Choudhary

Bhan

, et al. Late outcome after arterial switch operation for complete transposition of great arteries with left ventricular outflow tract obstruction. Ann Thorac Surg. 2002;74(6):1986-1991. doi:https://doi.org/10.1016/S0003-4975(02)04078-X

11.

Esmaeil

Jacobs

Tchervenkov

, et al. TGA + IVS + LVOTO: patterns of practice and outcomes. Cardiol Young. 2023;33(3):342-348. doi:https://doi.org/10.1017/S1047951122003924

12.

Emani

Beroukhim

Zurakowski

, et al. Outcomes after anatomic repair for d-transposition of the great arteries with left ventricular outflow tract obstruction. Circulation. 2009;120(11_suppl_1):S53-S58. doi:https://doi.org/10.1161/CIRCULATIONAHA.108.843102

13.

Honjo

Kotani

Bharucha

, et al. Anatomical factors determining surgical decision-making in patients with transposition of the great arteries with left ventricular outflow tract obstruction. Eur J Cardiothorac Surg. 2013;44(6):1085-1094. doi:https://doi.org/10.1093/ejcts/ezt283

14.

Vida

Zanotto

, et al. Left-sided reoperations after arterial switch operation: a European multicenter study. Ann Thorac Surg. 2017;104(3):899-906. doi:https://doi.org/10.1016/j.athoracsur.2017.04.026

15.

Nakayama

Shinkawa

Matsumura

Hoki

Kobayashi

Niinami

. Late neo-aortic valve regurgitation long after arterial switch operation. Ann Thorac Surg. 2019;108(4):1210-1216. doi:https://doi.org/10.1016/j.athoracsur.2019.04.009

16.

Jex

Puga

Julsrud

Weidman

. Repair of transposition of the great arteries with intact ventricular septum and left ventricular outflow tract obstruction. J Thorac Cardiovasc Surg. 1990;100(5):682-686. doi:https://doi.org/10.1016/s0022-5223(19)35465-0

17.

Furuta

Yamagishi

Matsumura

Shinkawa

Niinami

. Long-term surgical results of transposition of the great arteries with left ventricular outflow tract obstruction. J Cardiothorac Surg. 2022;17(1):1-8. doi:https://doi.org/10.1186/s13019-022-01869-9

18.

Raju

Myers

Quinonez

, et al. Aortic root translocation (Nikaidoh procedure): intermediate follow-up and impact of conduit type. J Thorac Cardiovasc Surg. 2015;149(5):1349-1355. doi:https://doi.org/10.1016/j.jtcvs.2014.11.014

19.

Hazekamp

Portela

Bartelings

. The optimal procedure for the great arteries and left ventricular outflow tract obstruction. An anatomical study. Eur J Cardiothorac Surg. 2007;31(5):880-888. doi:https://doi.org/10.1016/j.ejcts.2007.02.014

20.

Yeh

Ramaciotti

Leonard

Roy

Nikaidoh

. The aortic translocation (Nikaidoh) procedure: midterm results superior to the Rastelli procedure. J Thorac Cardiovasc Surg. 2007;133(2):461-469. doi:https://doi.org/10.1016/j.jtcvs.2006.10.016

21.

Roubertie

Thambo

Bretonneau

, et al. Late outcome of 132 senning procedures after 20 years of follow-up. Ann Thorac Surg. 2011;92(6):2206-2214. doi:https://doi.org/10.1016/j.athoracsur.2011.06.024

22.

Pundi

Johnson

Dearani

, et al. 40-year follow-up after the fontan operation long-term outcomes of 1,052 patients. J Am Coll Cardiol. 2015;66(15):1700-1710. doi:https://doi.org/10.1016/j.jacc.2015.07.065

23.

Poh

d’Udekem

. Life after surviving fontan surgery: a meta-analysis of the incidence and predictors of late death. Heart Lung Circ. 2018;27(5):552-559. doi:https://doi.org/10.1016/j.hlc.2017.11.007