Abstract 17117: Prevalence of Systemic AV Valve Regurgitation in Patients With Congenitally Corrected Transposition of the Great Arteries: Anatomic versus Physiologic Repair

Abstract

Background: Congenitally corrected transposition of the great arteries (ccTGA) is a rare anomaly with highly variable time of diagnosis. Depending on time of diagnosis and associated lesions, multiple therapies exist, directed towards surgical correction. Anatomic repair (AR) involving double switch or atrial switch/Rastelli and physiologic repair (PR) leaving the right ventricle as the systemic ventricle are the two main surgical options. A subset of patients without associated lesions exist who can be followed expectantly over time. Systemic atrioventricular valve (SAVV) function is a major anatomic variable, determining eligibility for double switch and durability of physiologic repair or expectant management (medical group). We therefore sought to assess the prevalence of AV valve regurgitation in the different subgroups and its determinants, hypothesizing that SAVV regurgitation (SAVVR) was reduced in the AR group. Methods: Retrospective record review coupled with prospective cross-sectional follow-up of 240 patients with ccTGA treated at our center was performed. Echocardiographic imaging review was conducted to assess SAVV function and systemic ventricular function among the 3 subgroups. Results: Of 240 patients with ccTGA, 162 met inclusion. Median follow up was 10 years (mean +/- SD 11+/- 9 years). In the AR group majority (85%) had none/mild SAVVR. Prior PA band did not influence the severity of SAVVR following double switch. In the PR group, 22% underwent SAVV repair/replacement, and 75% had none/mild SAVVR; as opposed to only 65% with none/mild SAVVR in the medical group. Only 14% of patients were free of systemic ventricle dysfunction in PR group as opposed to 72% in the AR group. Conclusions: SAVV function is preserved in the AR group. In contrast patients in the PR group had higher prevalence of more than mild SAVVR followed by patients who were managed expectantly.