In congenitally corrected transposition of the great arteries 10-years-mortality is not determined by the type of operation

Objective: The surgical concepts for patients with congenitally corrected transposition of the great arteries (CCTGA) include biventricular repair with or without correcting discordant connections or univentricular palliation. Presence of associated lesions, such as ventricular septal defect (VSD), pulmonary stenosis (PS), tricuspid insufficiency (TI), or functionally single ventricle (SV) need to be taken into account. Methods: All patients with CCTGA, who underwent biventricular repair either without (n=39), or with (n=6) correction of discordant connections, or univentricular palliation (n=11) between 1978 and 2006 were analyzed. Associated lesions were present in all patients (VSD n=48, PS n=39, TI n=20, and SV n=11). Results: Thirty-day mortality was 4%. During a mean follow-up of 7.2±7.1 years (maximum 27 years), there were 6 deaths and 2 heart transplantations. Freedom from death or transplantation was not significantly different between patients who underwent biventricular repair either with or without correcting discordant connections, or univentricular palliation (83.3±15.2%, 79.7±6.9%, 90.9±8.7% at 10 years, respectively). Among associated lesions, type of operation, and age at the time of operation, presence of TI emerged as the only risk factor for death or transplantation in multivariate analysis (p=0.004, hazard rate 10.4, 95% confidence interval 2.1–50.0). Twenty patients required reoperation, mainly for TI (n=10) and conduit failure (n=6). Conclusions: Tricuspid insufficiency is the main influencing factor for late death and reoperation. Outcome in terms of late mortality is not influenced by the surgical concept.