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Congenitally Corrected Transposition of the Great Arteries: Mid-term Outcomes of Different Surgical Strategies

BACKGROUND: Optimal management for congenitally corrected transposition of the great arteries (ccTGA) is controversial. We applied different surgical strategies based on individual variations in our single-centered practice over 10 years, aming to describe the mid-term results. METHODS: From January...

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Autores principales: He, Xiaomin, Shi, Bozhong, Song, Zhiying, Pan, Yanjun, Luo, Kai, Sun, Qi, Zhu, Zhongqun, Xu, Zhiwei, Zheng, Jinghao, Zhang, Zhifang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8850704/
https://www.ncbi.nlm.nih.gov/pubmed/35186821
http://dx.doi.org/10.3389/fped.2021.791475
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author He, Xiaomin
Shi, Bozhong
Song, Zhiying
Pan, Yanjun
Luo, Kai
Sun, Qi
Zhu, Zhongqun
Xu, Zhiwei
Zheng, Jinghao
Zhang, Zhifang
author_facet He, Xiaomin
Shi, Bozhong
Song, Zhiying
Pan, Yanjun
Luo, Kai
Sun, Qi
Zhu, Zhongqun
Xu, Zhiwei
Zheng, Jinghao
Zhang, Zhifang
author_sort He, Xiaomin
collection PubMed
description BACKGROUND: Optimal management for congenitally corrected transposition of the great arteries (ccTGA) is controversial. We applied different surgical strategies based on individual variations in our single-centered practice over 10 years, aming to describe the mid-term results. METHODS: From January 2008 to June 2021, 90 patients with ccTGA were reviewed and grouped by three different surgical strategies: 41 cases with biventricular correction as biventricular group, 11 cases with 1.5 ventricular correction as 1.5 ventricular group, and 38 cases with Fontan palliation as univentricular group. The mean age at primary surgery was 41.4 ± 22.7 months. Patients were followed for mortality, complications, reoperation, cardiac function, and valve status. RESULTS: The median follow-up period was 5.1 years (range, 1.5–12.5 years). The overall 10-year survival and freedom from reoperation rate was 86.7 and 82.4%, respectively. There were 3 early deaths and 3 mid-term deaths in the biventricular group, while 2 early deaths and 1 mid-term deaths were reported in the univentricular group. Although 1.5 ventricular group presented no death and the fewest complications, we still found similar mortality (p = 0.340) and morbidity (p = 0.670) among the three groups. The bypass time, aortic-clamp time, and ICU stay length were the longest in the biventricular group, followed by the 1.5 ventricular group (p < 0.001). However, in mid-term follow-up, biventricular and 1.5 ventricular groups both showed excellent cardiac function and obvious improvement of tricuspid regurgitation (p = 0.008 and p = 0.051, respectively). Fontan palliation provided acceptable mid-term outcomes as well, despite a lower ejection fraction. CONCLUSION: Satisfactory mid-term outcomes could be achieved for highly selected ccTGA patients using the whole spectrum of surgical techniques. Moreover, 1.5 ventricular correction, as a new emerging technique in recent years, might hold great promise in future practice.
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spelling pubmed-88507042022-02-18 Congenitally Corrected Transposition of the Great Arteries: Mid-term Outcomes of Different Surgical Strategies He, Xiaomin Shi, Bozhong Song, Zhiying Pan, Yanjun Luo, Kai Sun, Qi Zhu, Zhongqun Xu, Zhiwei Zheng, Jinghao Zhang, Zhifang Front Pediatr Pediatrics BACKGROUND: Optimal management for congenitally corrected transposition of the great arteries (ccTGA) is controversial. We applied different surgical strategies based on individual variations in our single-centered practice over 10 years, aming to describe the mid-term results. METHODS: From January 2008 to June 2021, 90 patients with ccTGA were reviewed and grouped by three different surgical strategies: 41 cases with biventricular correction as biventricular group, 11 cases with 1.5 ventricular correction as 1.5 ventricular group, and 38 cases with Fontan palliation as univentricular group. The mean age at primary surgery was 41.4 ± 22.7 months. Patients were followed for mortality, complications, reoperation, cardiac function, and valve status. RESULTS: The median follow-up period was 5.1 years (range, 1.5–12.5 years). The overall 10-year survival and freedom from reoperation rate was 86.7 and 82.4%, respectively. There were 3 early deaths and 3 mid-term deaths in the biventricular group, while 2 early deaths and 1 mid-term deaths were reported in the univentricular group. Although 1.5 ventricular group presented no death and the fewest complications, we still found similar mortality (p = 0.340) and morbidity (p = 0.670) among the three groups. The bypass time, aortic-clamp time, and ICU stay length were the longest in the biventricular group, followed by the 1.5 ventricular group (p < 0.001). However, in mid-term follow-up, biventricular and 1.5 ventricular groups both showed excellent cardiac function and obvious improvement of tricuspid regurgitation (p = 0.008 and p = 0.051, respectively). Fontan palliation provided acceptable mid-term outcomes as well, despite a lower ejection fraction. CONCLUSION: Satisfactory mid-term outcomes could be achieved for highly selected ccTGA patients using the whole spectrum of surgical techniques. Moreover, 1.5 ventricular correction, as a new emerging technique in recent years, might hold great promise in future practice. Frontiers Media S.A. 2022-02-03 /pmc/articles/PMC8850704/ /pubmed/35186821 http://dx.doi.org/10.3389/fped.2021.791475 Text en Copyright © 2022 He, Shi, Song, Pan, Luo, Sun, Zhu, Xu, Zheng and Zhang. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pediatrics
He, Xiaomin
Shi, Bozhong
Song, Zhiying
Pan, Yanjun
Luo, Kai
Sun, Qi
Zhu, Zhongqun
Xu, Zhiwei
Zheng, Jinghao
Zhang, Zhifang
Congenitally Corrected Transposition of the Great Arteries: Mid-term Outcomes of Different Surgical Strategies
title Congenitally Corrected Transposition of the Great Arteries: Mid-term Outcomes of Different Surgical Strategies
title_full Congenitally Corrected Transposition of the Great Arteries: Mid-term Outcomes of Different Surgical Strategies
title_fullStr Congenitally Corrected Transposition of the Great Arteries: Mid-term Outcomes of Different Surgical Strategies
title_full_unstemmed Congenitally Corrected Transposition of the Great Arteries: Mid-term Outcomes of Different Surgical Strategies
title_short Congenitally Corrected Transposition of the Great Arteries: Mid-term Outcomes of Different Surgical Strategies
title_sort congenitally corrected transposition of the great arteries: mid-term outcomes of different surgical strategies
topic Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8850704/
https://www.ncbi.nlm.nih.gov/pubmed/35186821
http://dx.doi.org/10.3389/fped.2021.791475
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