Complete transposition of the great arteries - surgical results and prognosis

Abstract

Objectives : The aim of this study was to analyze the surgical results and the prognosis in patients with complete transposition of the great arteries (TGA). Study design : A group of 64 children with complete TGA out of 272 patients with critical congenital heart disease (CCHD) from the region of North-East Bulgaria was retrospectively followed for a period of 25 years (1987-2011 year). Methods of investigations include: clinical examination, electrocardiography, conventional radiography, echocardiography and cardiac catheterization. Surgical results were based on a scale, elaborated by us. Results : Complete TGA is the most frequent CCHD in the region of North-East Bulgaria - 23%, and in 64.1% of the cases it was associated with other cardiac malformations. Surgical correction was performed in 41 of the children (64.1%) with TGA - an average 2.17 interventions on each patient. The overall postoperative mortality rate was 43.9% and it was highest if concomitant lesions were presented, such as pulmonary stenosis or atresia, criss-cross atrioventricular connection and others - up to 50-60%. The balloon atrioseptostomy was the most common initial palliative procedure, performed in 83% of the newborns at a mean age of 7.1days and a mortality rate - 8.8%. In 31 of the children (75.6%) a complete corrective intervention was made. The most frequent was arterial switch operation (ASO) - 16 children (51%). Six of the children died - 37.5%, but the mean age of which the surgery was performed was significantly higher - 32.2 days in contrast to 16.8 days for the whole group (p<0.05). The surgical results on the 5th year were assessed as good/very good in 4 of the children and satisfactory in 1 child. Senning procedure was performed in 8 of the patients (26%) with a mortality rate of 25%. Four of the children (13%) undergone Rastelli or REV procedure and 3 of them (10%) had one-chambered Fontan procedure. Conclusions : Complete TGA is the most frequent CCHD. The associated cardiac malformations have significant influence upon the prognosis and the surgical results. On different reasons still significantly high number of children with TGA remains without corrective interventions. The fundamental corrective procedure is ASO and the delayed intervention leads to unsatisfactory postoperative results.