Transposition of the Great Arteries With Intact Ventricular Septum and Left Ventricular Outflow Tract Obstruction: An Analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD).

Abstract

PurposeTransposition of the great arteries with intact ventricular septum and left ventricular outflow tract obstruction (TGA + IVS + LVOTO) is a rare congenital cardiac malformation. This study aims to describe the operations performed for patients with TGA + IVS + LVOTO in the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) and review their short-term outcomes.MethodsA total of 112 patients with the diagnosis of TGA + IVS + LVOTO in the STS-CHSD who underwent cardiac surgery between January 1999 and June 2021 were included. Patients' characteristics, operative data, and postoperative outcomes were analyzed.ResultsA total of 120 index cardiac operations were performed. The most common operations were the arterial switch procedure (n = 33), Glenn/HemiFontan (n = 10), Fontan (n = 9), Rastelli with ventricular septal defect (VSD) creation (n = 6), Damus-Kaye-Stansel procedure (n = 5), heart transplant (n = 5), and atrial switch (n = 4). Concomitant repair of subvalvar aortic stenosis was coded in 7 of 33 patients undergoing the arterial switch operation. The overall operative mortality was 4.5% (5 deaths in 112 patients undergoing 120 index cardiac operations). The overall major complication rate was 19% (23 of 120 cases). Major complications occurred in 9 of 33 (27%) of the arterial switch operations. The most common complications were unplanned reoperation in 14 of 120 cases (12%) arrhythmias requiring pacemaker implantation in 5 of 120 (4.2%), and postoperative mechanical circulatory support in 4 of 120 (3.3%).ConclusionThe diagnosis of TGA + IVS + LVOTO is rare in the STS-CHSD. The most common procedures performed for this disease were the arterial switch operation (often with concomitant repair of subvalvar aortic stenosis), Rastelli with VSD creation, and palliative functionally univentricular operations.