Outcomes After Anatomic Versus Physiologic Repair of Congenitally Corrected Transposition of the Great Arteries: A Systematic Review and Meta-Analysis

Abstract

Surgical treatment for congenitally corrected transposition of the great arteries is widely debated, with both physiologic repair and anatomic repair holding advantages and disadvantages. This meta-analysis, which includes 44 total studies consisting of 1857 patients, compares mortality at different time points (operative, in-hospital, and post-discharge), reoperation rates, and postoperative ventricular dysfunction between these two categories of procedures. Although anatomic and physiologic repair had similar operative and in-hospital mortality, anatomic repair patients had significantly less post-discharge mortality (6.1% vs 9.7%; P = .006), lower reoperation rates (17.9% vs 20.6%; P < .001), and less postoperative ventricular dysfunction (16% vs 43%; P < .001). When anatomic repair patients were subdivided into those who had atrial and arterial switch versus those who had atrial switch with Rastelli, the double switch group had significantly lower in-hospital mortality (4.3% vs 7.6%; P = .026) and reoperation rates (15.6% vs 25.9%; P < .001). The results of this meta-analysis suggest a protective benefit of favoring anatomic repair over physiologic repair.

Keywords

congenital heart disease congenital heart surgery hypoplastic left heart syndrome statistics meta-analysis

Introduction

Congenitally corrected transposition of the great arteries (ccTGA) (also known as levo-TGA) is a rare condition present in <1% of all congenital heart diseases. The condition is characterized by ventriculo-arterial and atrioventricular discordance.¹ ccTGA is also frequently associated with other structural lesions of the heart in 80% to 90% of cases, including ventricular septal defect (VSD) (70%), pulmonic stenosis (40%), and Ebstein's anomaly (33%).¹

The optimal surgical management of ccTGA remains a controversial topic. Comparative long-term outcomes of the physiologic and anatomic repairs remain unclear. The physiologic repair, in which the morphologic right ventricle remains as the systemic ventricle and other underlying defects such as a VSD are repaired, has historically been the preferred approach.² In the more extensive and technically challenging anatomic repair (with double switch operation, or atrial switch-Rastelli/REV/Nikaidoh), the removal of the right ventricle from the high-pressure systemic circulation mitigates the potential for right ventricular strain and subsequent heart failure.^3-5 Currently, no randomized clinical trials exist comparing outcomes between the anatomic and physiologic repairs for ccTGA. However, several retrospective studies have been published in the literature comparing outcomes between the 2 groups. A meta-analysis in 2006 by Alghamdi et al demonstrated better outcomes of the Rastelli operation compared to the physiologic repair after surveying the results of 11 studies consisting of 124 patients from 1983 to 2000. Fueled by the wealth of new data describing the 2 types of ccTGA repairs, as well as the growing interest in this field by congenital cardiac surgeons, the aim of this meta-analysis is to update the literature using studies from 2001 to 2021. Specifically, we hypothesize that anatomic repair demonstrates a significant advantage over physiologic repair with respect to the primary outcomes of mortality (operative, in-hospital, and post-discharge), reoperation rates, and ventricular dysfunction.

Patients and Methods

A systematic literature review was conducted using the databases PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase in June of 2021. All studies published between 2001 and 2021 were considered for review. The search syntax strategy was created using terms related to the clinical outcome. The terms “transposition of the great vessels,” “anatomic repair,” “physiologic repair,” “Mustard,” “Senning,” “Rastelli,” and “double-switch” were separated with the Boolean operators AND/OR. The complete search strategy is provided in Appendix 1.

Study selection was performed by 2 reviewers through title and abstract screening, followed by full-text review. Inclusion criteria were clinical studies reporting mortality and reoperation outcomes data on patients with ccTGA who had undergone either physiologic or anatomic repair (a Senning or Mustard atrial switch combined with either an arterial switch or ventricular level repair for ccTGA). Studies that did not include outcome data, including technique articles, review articles, and editorial responses, as well as non-English articles, articles published before 2001, and articles that included conditions aside from ccTGA were excluded.

Relevant studies were included for data extraction, while irrelevant or ineligible studies (including, but not limited to, manuscripts that were clearly not outcomes-based studies, single-patient case reports, studies that focused on dextro-transposition of the great arteries), studies that focused on diagnoses other than ccTGA, and studies that investigated outcomes after surgical repair that were clearly not anatomic or physiologic (eg, transplantation) were excluded. A data manager was used to facilitate study selection (Covidence, Systematic Review Software). A data extraction table was created and completed; collected data included mean/median age at operation, mean/median follow-up, baseline pulmonic valve abnormality, baseline tricuspid valve abnormality, prior shunt operation, VSD, prior pulmonary artery banding, complete heart block requiring permanent pacemaker implantation, mortality (operative, in-hospital, and post-discharge), 10-year survival, 20-year survival, reoperation, and ventricular dysfunction for both physiologic patients and anatomic patients.

Data Analysis

The study population was divided into physiologic and anatomic groups; anatomic patients were further subdivided into atrial switch (Senning or Mustard)-arterial switch repair (ASAS subgroup), atrial switch-ventricular/Rastelli repair (ASVR subgroup), and “other” groups (such as heart transplantation or Glenn alone). Baseline characteristics, including age at operation, year of operation, pulmonic and tricuspid valve abnormalities (including Ebstenoid malformations and moderate to severe tricuspid regurgitation), VSD, prior shunts, and prior pulmonary artery banding were reported for the selected studies. Because patient level data were unavailable for most of the included studies, aggregate mortality, reoperation rates, and postoperative ventricular dysfunction were compared between physiologic and anatomic groups. The anatomic subgroups ASAS and ASVR were also compared against each other for mortality and reoperation analysis. These outcomes were extracted as the number of events in each group and were pooled using an inverse variance method and reported as odds ratio (OR) with a 95% confidence interval (95% CI) using 2-sided t-tests. In all analyses, physiologic repair was the reference group. In the ASAS versus ASVR comparison, ASAS was the reference group.

For follow-up outcomes, we also took into account the different lengths of follow-up in each study, and thus these endpoints were analyzed by pooling the natural logarithm of the incidence rate ratio (IRR), which represents the number of events observed per total number of patient-years. Pooled meta-analytic estimates were obtained using the inverse variance method with a fixed and random effect model.

Statistical heterogeneity and consistency were assessed with I², which describes the percentage of variability in an effect that is due to heterogeneity rather than sampling error (chance). Low, moderate, and high heterogeneity were defined as I² less than 25%, 25% to 50%, and more than 50%, respectively. The presence of a small-study effect was assessed visually by inspection of the funnel plot and quantitatively by means of Egger's test. All statistical analyses were performed in R (version 4.0.3; R Project; R Foundation for Statistical Computing). A P value <.05 was determined to be statistically significant.

Results

The search criteria yielded 3219 unique results; 3131 were deemed irrelevant based on title and abstract screening, and another 45 studies were excluded after full-text review. Reasons for exclusion were as follows: insufficient patient data (9 studies) (eg, studies that combined operative and nonoperative patients in one cohort but did not provide data for analysis on operative patients separately), wrong study design (17 studies) (eg, review articles), wrong patient population (7 studies) (eg, patients with diagnoses other than ccTGA), before the year 2001 (8 studies), and wrong outcomes (4 studies) (eg, studies that focused on other outcomes such as quality of life and not mortality or reoperation). The remaining 44 studies were included for data extraction (Figure 1).

The 44 included studies (Table 1) comprised 1857 total patients (535 in physiologic group vs 1322 in anatomic group), with a mean age at operation of 11.1 years (physiologic) and 3.6 years (anatomic). The sample sizes ranged from 2 to 167 total patients. Within the anatomic group, there were 627 ASAS patients and 616 ASVR patients. In the anatomic group, the 79 patients in the “other” category were excluded from further analysis due to heterogeneity of the repair types used and small sample size.

Table 1.

Characteristics and Demographics of Included Studies for Analysis.

Study	Year of Publication	Year of Surgery	# of Patients (Total)	# of Patients (Physiologic)	# of Patients (Anatomic)
Adachi et al⁶	2016	1970-2000	16	16	0
Bautista et al⁷	2014	1992-2012	106	0	106
Bilal et al⁸	2016	1995-2015	16	0	16
Bogers et al⁹	2010	1972-2008	29	29	0
Brizard et al¹⁰	2017	1996-2015	32	0	32
Cui et al¹¹	2014	2005-2011	14	0	14
Cui et al¹²	2021	1980-2019	128	91	37
De Leon et al¹³	2017	1995-2016	44	18	26
Devaney et al¹⁴	2003	1993-2002	17	0	17
Duncan et al¹⁵	2003	1993-2002	46	0	46
Ferro et al¹⁶	2016	2005-2014	17	0	17
Gaies et al¹⁷	2009	1993-2009	65	0	65
Hiramatsu et al¹⁸	2012	1983-2010	90	0	90
Hirose et al¹⁹	2015	1960-2005	23	23	0
Hoashi et al²⁰	2013	1987-2011	47	0	47
Hirose et al²¹	2008	1978-2006	45	39	6
Hraska et al²²	2005	1963-1996	96	96	0
Hraska et al²³	2017	1997-2016	63	0	63
Hsu et al²⁴	2016	1995-2012	33	15	18
Hua et al²⁵	2009	1996-2005	93	75	18
Ibrahimiye et al²⁶	2017	2003-2015	18	0	18
Ilibawi et al²⁷	2002	1989-2000	12	0	12
Imai et al²⁸	2001	1989-2000	76	0	76
Langley et al²⁹	2003	1991-2001	54	0	54
Lenoir et al³⁰	2018	1990-2015	39	0	39
Lim et al³¹	2010	1983-2009	167	123	44
Ly et al³²	2009	1995-2007	20	0	20
Ma et al³³	2020	2005-2016	85	0	85
Malhotra et al³⁴	2011	1994-2009	48	0	48
Marathe et al³⁵	2017	1998-2016	12	0	12
Murtuza et al³⁶	2011	1991-2011	113	0	113
Pecoraro et al³⁷	2003	2002	3	0	3
Sachdeva et al³⁸	2017	2001-2015	15	0	15
Sen-Hild et al³⁹	2020	1993-2020	17	10	7
Sharma et al²	2009	1994-2007	68	0	68
Shim et al⁴⁰	2017	1996-2013	16	0	16
Sojak et al⁴¹	2012	2004-2011	8	0	8
Subtaweesin et al⁴²	2005	2001-2002	3	0	3
Tam et al⁴³	2020	2007-2017	8	0	8
Tocharoenchok et al⁴⁴	2016	2001-2014	22	0	22
Wu et al⁴⁵	2001	1998-1999	2	0	2
Zhang et al⁴⁶	2017	2011-2015	31	0	31

The mean age of the cohorts in each included study at the time of operation ranged from 4.1 to 16.8 years (physiologic) and 0.6 to 10.9 years (anatomic), and the overall range of ages across all studies was 1 week to 71 years (physiologic) and 5 days to 43 years (anatomic). 175 (57%) physiologic and 961 (80%) anatomic patients had an associated VSD; 66 (67%) physiologic and 537 (60%) anatomic patients had preoperative pulmonic valve abnormalities; 102 (24%) physiologic and 319 (28%) anatomic patients had tricuspid valve abnormalities; 11 (32%) physiologic and 334 (38%) anatomic patients had undergone a previous shunt procedure; and 403 (33%) anatomic and 24 (16%) physiologic patients had undergone prior PA banding (Table 2). The mean follow-up periods were 11.5 years and 5.4 years among physiologic and anatomic groups, respectively.

Table 2.

Preoperative Patient Characteristics.

Variable	Physiologic Repair	Anatomic Repair	P value
Baseline pulmonic valve abnormality	66/99 (67%)	537/893 (60%)	.197
Baseline tricuspid valve abnormality	102/432 (24%)	319/1136 (28%)	.078
Baseline VSD	175/309 (57%)	9611204/ (80%)	<.00001
Baseline shunt procedure	11/34 (32%)	334/873 (38%)	.477
Prior pulmonary artery banding	24/153 (16%)	403/1208 (33%)	<.0001

Abbreviation: VSD, ventricular septal defect.

A total of 237 patients died during either their operations or follow-up. In the physiologic group, the overall mortality rate was 14% (n = 77), operative mortality was 0.7% (n = 4), in-hospital mortality was 3.9% (n = 21), and post-discharge mortality was 9.7% (n = 52). In the anatomic group, the overall mortality rate was 12.1% (n = 60) operative mortality was 0.4% (n = 5), in-hospital mortality was 5.7% (n = 75), and post-discharge mortality was 6.1% (n = 80). A total of 346 patients required reoperations, 110 in the physiologic group (reoperation rate of 21%) and 236 in the anatomic group (reoperation rate of 18%). With regard to valve-related reoperations, 86 (19%) patients in the physiologic group had systemic tricuspid valve reoperations, while 7 (0.8%) patients in the anatomic group had systemic mitral valve reoperations and 16 (1.8%) patients had aortic valve reoperations. Finally, among patients in the physiologic group, residual or acquired tricuspid valve regurgitation of at least moderate severity was seen in 71 (32%) patients, whereas in the anatomic repair group, residual or acquired mitral, aortic, or tricuspid valve regurgitation of at least moderate severity was seen in 32 (4.7%), 31 (4.5%), and 37 (5.8%) patients, respectively.

Univariable logistic regression results are reported in Table 3. Although anatomic repair and physiologic repair demonstrated similar operative and in-hospital mortality, physiologic repair was associated with a statistically significant increase in post-discharge mortality (OR 1.671, P = .006, 95% CI 1.155-2.399), reoperation (OR 1.671, P < .001, 95% CI 1.679-2.896), postoperative ventricular dysfunction (OR 3.896, P < .001, 95% CI 3.002-5.057), and complete heart block requiring permanent pacemaker placement (OR 4.094, P < .001, 95% CI 3.083-5.438) when compared with anatomic repair. Although ASAS and ASVR subgroups had similar operative and post-discharge mortality rates, the ASVR subgroup was associated with a significant increase in in-hospital mortality (OR 1.825, P = .026, 95% CI 1.083-3.144) and reoperation rates (OR 1.886, P < .001, 95% CI 1.347-2.661) when compared with the ASAS group. The proportion of LV dysfunction was not different between the ASAS (17%, 95% CI 14%-21%) and ASVR (11%, 95% CI 8%-17%; P = .08).

Table 3.

Odds Ratios of Mortality, Reoperation, and Postoperative Ventricular Dysfunction Outcomes for Anatomic Versus Physiologic Repair, and “ASAS” Versus “ASVR” Repair.

Outcome measure	Anatomic	Physiologic	Odds Ratio^a	P value	Confidence Interval
Operative mortality	5 (0.4%)	4 (0.9%)	1.984	.308	0.484-7.527
In-hospital mortality	75 (5.7%)	21 (3.9%)	0.679	.125	0.405-1.094
Post-discharge mortality	80 (6.1%)	52 (9.7%)	1.671	.006	1.155-2.399
Reoperation rate	236 (17.9%)	110 (20.6%)	1.671	<.001	1.679-2.896
Systemic ventricular dysfunction	142 (16%)	190 (43%)	3.896	<.001	3.002-5.057
Outcome measure	ASAS	ASVR	Odds Ratio^a	P value	Confidence Interval
Operative mortality	2 (0.4%)	1 (0.2%)	0.509	.582	0.024-5.335
In-hospital mortality	23 (4.3%)	39 (7.6%)	1.825	.026	1.083-3.144
Post-discharge mortality	29 (5.3%)	42 (8.0%)	1.547	.080	0.953-2.546
Reoperation rate	67 (15.6%)	109 (25.9%)	1.886	<.001	1.347-2.661

^aOdds ratios are reported as physiologic/anatomic and ASVR/ASAS.

The results of the pairwise meta-analysis, based on 5 studies, for follow-up mortality and reoperation are presented in Supplemental Figures 1 to 3. There was no evidence of publication bias and small-study effect in the studies included in the pairwise meta-analysis (Supplemental Figures 4-6).

Comment

In this meta-analysis, the anatomic repair was associated with a statistically significant decrease in post-discharge mortality, reoperation, and postoperative systemic ventricular dysfunction when compared with the physiologic repair. Physiologic repair of ccTGA has conventionally been the favored treatment and has been shown to carry acceptable short-term results; however, the long-term outcomes have proven suboptimal as systemic tricuspid and RV abnormalities are often unavoidable insofar as the RV is not well-suited to withstand high systemic pressures.³¹ Whether the anatomic or physiologic repair should be the gold standard for surgical treatment of ccTGA is still unknown, given the scarcity of large or multicentric studies. Alghamdi et al's meta-analysis from 2006 showed significantly lower in-hospital mortality after the atrial-switch/Rastelli anatomic repair.³ No meta-analysis has since been published including the most recent clinical outcome studies on ccTGA. Consequently, concerns remain regarding the risks of operative and postoperative mortality, as well as reoperation after the surgical management of ccTGA.

This meta-analysis examines the rates of mortality at different time points (operative, in-hospital, and post-discharge), as well as the reoperation rates in anatomic and physiologic repairs of ccTGA. The 44 studies with a total of 1857 patients in our analysis revealed that while the 2 approaches fared similarly with respect to operative and in-hospital mortality risk, anatomic repair seems to be associated with a lower risk of post-discharge mortality, reoperation risk, and postoperative ventricular dysfunction. These better outcomes of the anatomic repair are likely related to “re-positioning” of the left ventricle into the systemic position. Interestingly, our study also demonstrates that the anatomic repair is associated with a non-negligeable rate of systemic LV dysfunction at a mean follow-up of 5.4 years. The subgroup analysis of anatomic repair demonstrated better outcomes of the ASAS repair compared to the ASVR repair. This last finding stands in contrast to Alghamdi et al's meta-analysis in which the atrial switch/Rastelli operation was found to be superior to an atrial–arterial double switch.³ The better outcomes of ASAS patients in our study are likely due to their more favorable preoperative anatomy. Indeed, significant baseline pulmonic outflow tract obstruction makes patients unsuitable candidates for successful atrial–arterial switch and are thus recommended for an atrial–Rastelli repair.⁴⁷

This meta-analysis is not without limitations. In reviewing the current literature, we analyzed studies that included either aggregate patient data or individual-level data. Although Alghamdi et al's meta-analysis included papers with only individual level data to permit more extensive analysis, our decision-making tipped the balance in favor of including studies with aggregate patient data as well to increase our sample size and provide a more representative survey of mortality and reoperation outcomes. This decision, however, prevented the use of multivariable analysis with multiple independent patient variables. Furthermore, this approach also introduced significant variability among the included studies. The method of reporting age at the time of operation, including measures of dispersion, was not consistent across studies. It was therefore difficult to pool the age across all studies in order to determine whether there was a statistically significant difference in baseline preoperative status.

The different lengths of follow-up between anatomic and physiologic repair may introduce bias when comparing long-term outcomes by underestimating the rates of adverse events after the anatomic repair. To address this, we additionally calculated the IRRs for these outcomes. These IRRs represent the number of events observed per total number of patient-years, allowing the estimates to account for the different lengths in follow-up. This analysis revealed no statistically significant difference between the 2 groups for post-discharge mortality and reoperation rates. However, IRR calculations could be performed using only studies with a pair-wise comparison between anatomic and physiologic patients, which limited us to only 5 studies, thus making it difficult to draw any definitive conclusion from our IRRs. We were unable to calculate the IRR for systemic ventricular dysfunction because there were not enough studies with direct comparisons between the 2 repair groups for this variable to be accurately determined.

Although this study focused specifically on mortality, reoperation, and ventricular dysfunction outcomes, the multitude of other postoperative complications that may carry significant morbidity such as valvular incompetence, decompensated heart failure, and arrhythmias were not included in analysis. Although performing a large-scale randomized controlled trial comparing physiologic and anatomic repairs of ccTGA patients may be challenging given the rarity of the condition, such an analysis would shed light on these more detailed outcome measures as well as establish a causal effect of the initial operation.

Conclusion

There is no consensus among congenital cardiac surgeons regarding whether to proceed with anatomic or physiologic repair for patients with ccTGA. Although the anatomic repair undoubtedly promotes more favorable hemodynamics, as the left ventricle is restored to its position as the systemic ventricle, the procedure is more technically challenging. The results of this meta-analysis illustrate significantly decreased rates of post-discharge mortality, reoperation rates, and postoperative ventricular dysfunction in anatomic compared to physiologic patients, as well as significantly lower in-hospital mortality and reoperation in atrial–arterial switch compared to atrial–Rastelli patients.

Detailed patient-level data and a similar follow-up duration after the anatomic and physiologic repairs are required to more accurately create a model incorporating individual patient factors to better compare these groups.

Supplemental Material

sj-docx-1-pch-10.1177_21501351221127894 - Supplemental material for Outcomes After Anatomic Versus Physiologic Repair of Congenitally Corrected Transposition of the Great Arteries: A Systematic Review and Meta-Analysis

Supplemental material, sj-docx-1-pch-10.1177_21501351221127894 for Outcomes After Anatomic Versus Physiologic Repair of Congenitally Corrected Transposition of the Great Arteries: A Systematic Review and Meta-Analysis by Isao Anzai, Yanling Zhao, Arnaldo Dimagli, Christian Pearsall, Marian LaForest, Emile Bacha and David Kalfa in World Journal for Pediatric and Congenital Heart Surgery

Supplemental Material

sj-docx-2-pch-10.1177_21501351221127894 - Supplemental material for Outcomes After Anatomic Versus Physiologic Repair of Congenitally Corrected Transposition of the Great Arteries: A Systematic Review and Meta-Analysis

Supplemental material, sj-docx-2-pch-10.1177_21501351221127894 for Outcomes After Anatomic Versus Physiologic Repair of Congenitally Corrected Transposition of the Great Arteries: A Systematic Review and Meta-Analysis by Isao Anzai, Yanling Zhao, Arnaldo Dimagli, Christian Pearsall, Marian LaForest, Emile Bacha and David Kalfa in World Journal for Pediatric and Congenital Heart Surgery

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Marian LaForest

Supplemental Material

Supplemental material for this article is available online.

References

Baumgartner

Bonhoeffer

De Groot

, et al. ESC Guidelines for the management of grown-up congenital heart disease (new version 2010): the task force on the management of grown-up congenital heart disease of the European society of cardiology (ESC). Eur Heart J. 2010;31(23): 2915-2957.

Sharma

Talwar

Marwah

, et al. Anatomic repair for congenitally corrected transposition of the great arteries. J Thorac Cardiovasc Surg. 2009;137(2): 404-412. e404.

Alghamdi

McCrindle

Van Arsdell

. Physiologic versus anatomic repair of congenitally corrected transposition of the great arteries: meta-analysis of individual patient data. Ann Thorac Surg. 2006;81(4): 1529-1535.

Barron

Jones

Brawn

. The Senning procedure as part of the double-switch operations for congenitally corrected transposition of the great arteries. Semin Thorac Cardiovasc Surg Pediatr Cardiac Surg Annu. 2011;14(1): 109-115.

Brawn

. The double switch for atrioventricular discordance. Semin Thorac Cardiovasc Surg Pediatr Cardiac Surg Annu. 2005;8(1): 51-56.

Adachi

Masaki

Kawatsu

, et al. Long-term results after physiologic repair for congenitally corrected transposition of the great arteries. Gen Thorac Cardiovasc Surg. 2016;64(12): 715-721.

Bautista-Hernandez

Myers

Cecchin

Marx

Pedro

. Late left ventricular dysfunction after anatomic repair of congenitally corrected transposition of the great arteries. J Thorac Cardiovasc Surg. 2014;148(1): 254-258.

Bilal

Avşar

Yıldırım

, et al. Double switch procedure and surgical alternatives for the treatment of congenitally corrected transposition of the great arteries. J Card Surg. 2016;31(4): 231-236.

Bogers

Head

de Jong

Witsenburg

Kappetein

. Long term follow up after surgery in congenitally corrected transposition of the great arteries with a right ventricle in the systemic circulation. J Cardiothorac Surg. 2010;5(1): 1-7.

10.

Brizard

Lee

Zannino

, et al. Long-term results of anatomic correction for congenitally corrected transposition of the great arteries: a 19-year experience. J Thorac Cardiovasc Surg. 2017;154(1): 256-265. e254.

11.

Cui

Yan

, et al. The results of a two-stage double switch operation for congenital corrected transposition of the great arteries with a deconditioned morphologically left ventricle. Interact Cardiovasc Thorac Surg. 2014;19(6): 921-925.

12.

Cui

Hage

Piekarski

, et al.

Management of congenitally corrected transposition of the great arteries with intact ventricular septum: anatomic repair or palliative treatment?

Circ Cardiovasc Interventions. 2021;14(7): e010154.

13.

De León

Mery

Verm

, et al. Mid-term outcomes in patients with congenitally corrected transposition of the great arteries: a single center experience. J Am Coll Surg. 2017;224(4): 707-715.

14.

Devaney

Charpie

Ohye

Bove

. Combined arterial switch and Senning operation for congenitally corrected transposition of the great arteries: patient selection and intermediate results. J Thorac Cardiovasc Surg. 2003;125(3): 500-507.

15.

Duncan

Mee

Mesia

, et al. Results of the double switch operation for congenitally corrected transposition of the great arteries. Eur J Cardiothorac Surg. 2003;24(1): 11-20.

16.

Ferro

Murthy

Sebastian

Guleserian

Forbess

. Single-center experience with the Senning procedure in the current era. Paper presented at: Seminars in thoracic and cardiovascular surgery 2016.

17.

Gaies

Goldberg

Ohye

Devaney

Hirsch

Bove

. Early and intermediate outcome after anatomic repair of congenitally corrected transposition of the great arteries. Ann Thorac Surg. 2009;88(6): 1952-1960.

18.

Hiramatsu

Matsumura

Konuma

Yamazaki

Kurosawa

Imai

. Long-term prognosis of double-switch operation for congenitally corrected transposition of the great arteries. Eur J Cardiothorac Surg. 2012;42(6): 1004-1008.

19.

Hirose

Nishina

Kanemitsu

, et al. The long-term outcomes of physiologic repair for ccTGA (congenitally corrected transposition of the great arteries). Gen Thorac Cardiovasc Surg. 2015;63(9): 496-501.

20.

Hoashi

Kagisaki

Miyazaki

, et al. Anatomic repair for corrected transposition with left ventricular outflow tract obstruction. Ann Thorac Surg. 2013;96(2): 611-620.

21.

Hörer

Schreiber

Krane

, et al. Outcome after surgical repair/palliation of congenitally corrected transposition of the great arteries. Thorac Cardiovasc Surg. 2008;56(07): 391-397.

22.

Hraska

Duncan

Mayer

Jr Freed

Pedro

Jonas

. Long-term outcome of surgically treated patients with corrected transposition of the great arteries. J Thorac Cardiovasc Surg. 2005;129(1): 182-191.

23.

Hraska

Vergnat

Zartner

, et al. Promising outcome of anatomic correction of corrected transposition of the great arteries. Ann Thorac Surg. 2017;104(2): 650-656.

24.

Hsu

K-H

Chang

C-I

Huang

S-C

Chen

Y-S

Chiu

I-S

. 17-Year Experience in Surgical Management of Congenitally Corrected Transposition of the Great Arteries: A Single-Centre’s Experience. Oxford University Press; 2016.

25.

Hua

Pan

, et al. Operative and mid-term outcome of congenitally corrected transposition of great artery: 29. Cardiology. 2009;114.

26.

Ibrahimiye

Mainwaring

Patrick

Downey

Yarlagadda

Hanley

. Left ventricular retraining and double switch in patients with congenitally corrected transposition of the great arteries. World J Pediatr Congenit Heart Surg. 2017;8(2): 203-209.

27.

Ilbawi

Ocampo

Allen

, et al. Intermediate results of the anatomic repair for congenitally corrected transposition. Ann Thorac Surg. 2002;73(2): 594-600.

28.

Imai

Seo

Aoki

Shin’oka

Hiramatsu

Ohta

. Double-switch operation for congenitally corrected transposition. Paper presented at: Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery Annual 2001.

29.

Langley

Winlaw

Stumper

, et al. Midterm results after restoration of the morphologically left ventricle to the systemic circulation in patients with congenitally corrected transposition of the great arteries. J Thorac Cardiovasc Surg. 2003;125(6): 1229-1240.

30.

Lenoir

Bouhout

Gaudin

Raisky

Vouhé

. Outcomes of the anatomical repair in patients with congenitally corrected transposition of the great arteries: lessons learned in a high-volume centre. Eur J Cardiothorac Surg. 2018;54(3): 532-538.

31.

Lim

H-G

Lee

Kim

, et al. Outcomes of biventricular repair for congenitally corrected transposition of the great arteries. Ann Thorac Surg. 2010;89(1): 159-167.

32.

Belli

Leobon

, et al. Results of the double switch operation for congenitally corrected transposition of the great arteries. Eur J Cardiothorac Surg. 2009;35(5): 879-884.

33.

Hua

, et al. Surgical outcomes of anatomical repair for congenitally corrected transposed great arteries. Heart Lung Circ. 2020;29(5): 772-779.

34.

Malhotra

Reddy

Qiu

, et al. The hemi-Mustard/bidirectional Glenn atrial switch procedure in the double-switch operation for congenitally corrected transposition of the great arteries: rationale and midterm results. J Thorac Cardiovasc Surg. 2011;141(1): 162-170.

35.

Marathe

Jones

Ayer

, et al.

Congenitally corrected transposition: complex anatomic repair or Fontan pathway?

Asian Cardiovasc Thorac Ann. 2017;25(6): 432-439.

36.

Murtuza

Barron

Stumper

, et al. Anatomic repair for congenitally corrected transposition of the great arteries: a single-institution 19-year experience. J Thorac Cardiovasc Surg. 2011;142(6): 1348-1357. e1341.

37.

Pecoraro

Sreeram

Dodge-Khatami

Hitchcock

Bennink

. The double-switch procedure for atrioventricular and ventriculoarterial discordance. Neth Heart J. 2003;11(5): 210.

38.

Sachdeva

Jacobsen

Woods

, et al. Anatomic repair of congenitally corrected transposition of the great arteries: single-center intermediate-term experience. Pediatr Cardiol. 2017;38(8): 1696-1702.

39.

Sen-Hild

Yörüker

Sprengel

, et al. Surgical outcomes for congenitally corrected transposition of the great arteries with two ventricles. Thorac Cardiovasc Surg. 2020;68(S 01):DGTHG-V11.

40.

Shim

M-S

Jun

T-G

Yang

J-H

, et al. Clinical outcomes after anatomic repair including hemi-Mustard operation in patients with congenitally corrected transposition of the great arteries. Korean Circ J. 2017;47(2): 201-208.

41.

Sojak

Kuipers

Koolbergen

, et al. Mid-term results of bidirectional cavopulmonary anastomosis and hemi-Mustard procedure in anatomical correction of congenitally corrected transposition of the great arteries. Eur J Cardiothorac Surg. 2012;42(4): 680-684.

42.

Subtaweesin

Sriyoschati

. Early results of anatomic repair in a subgroup of corrected transposition. Asian Cardiovasc Thorac Ann. 2005;13(3): 208-210.

43.

Tam

Erez

Roten

, et al. Senning with aortic translocation, anatomic repair for congenitally corrected transposition. Ann Thorac Surg. 2020.

44.

Tocharoenchok

Sriyoschati

Tongcharoen

Tantiwongkosri

Subtaweesin

. Midterm results of anatomic repair in a subgroup of corrected transposition. Asian Cardiovasc Thorac Ann. 2016;24(5): 428-434.

45.

S-J

Chiu

Chen

S-J

, et al. Combined atrial and arterial switch operations for congenitally corrected transposition. J Formosan Med Assoc. 2001;100(1): 53-59.

46.

Zhang

, et al. The hemi-Mustard, bidirectional Glenn and Rastelli procedures for anatomical repair of congenitally corrected transposition of the great arteries/left ventricular outflow tract obstruction with positional heart anomalies. Eur J Cardiothorac Surg. 2017;51(6): 1058-1062.

47.

Imamura

Drummond-Webb

Murphy

Jr. , et al. Results of the double switch operation in the current era. Ann Thorac Surg. 2000;70(1): 100-105.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

21.30 MB

2.02 MB