Outcomes of Surgical Repair of Complex D-Transposition of the Great Arteries

Background: D-transposition of the great arteries (TGA) or TGA-type double outlet right ventricle (DORY) with ventricular septal defect (VSD) and left ventricular outflow tract obstruction (LVOTO) may be treated with the arterial switch operation (ASO), Rastelli, Reparation a l'Etage Ventriculaire (REV), or Nikaidoh procedures. We evaluated midterm results of these techniques. Methods: We retrospectively reviewed 42 cases of anatomic repair from 2005 to 2014 at our institution for TGA (n = 29) or TGA-type DORY (n = 13) with VSD and LVOTO. We analyzed outcomes (mortality, reoperation, residual/recurrent LVOT peak gradient >= 20 mm Hg, right ventricular outflow tract [RVOT] peak gradient >= 40 mm Hg) and performed a risk analysis. Mean follow-up was 5.77 +/- 3.08 years. Results: Seventeen (40.5%) patients had an ASO with (n = 4) or without (n = 13) LVOTO resection. The Rastelli, REV, and Nikaidoh procedures were used in 14 (33%), 5 (12%), and 6 (14%) patients, respectively. There were no mortalities or moderate aortic insufficiency at last follow-up. Three (9%) patients developed LVOT gradient >= 20 mm Hg, while nine (21.4%) patients had RVOT obstruction. Reoperations included RVOT/pulmonary artery reoperation (n = 10; 23.8%) and LVOT reoperation (n = 1; 2.5%). Freedom from reoperation was 84% +/- 6% and 75% +/- 9% at one and three years, respectively, for the entire cohort with no differences between groups by type of operation (log-rank P = .64). The Nikaidoh procedure compared favorably to all other techniques in terms of reoperation (n = 0/6; 0% vs n = 13/36; 36%; P = .08). Conclusions: Midterm outcomes after anatomic repair for TGA or TGA-type DORY with LVOTO and VSD are excellent but vary by surgical technique. The Nikaidoh procedure seems to compare favorably to the other techniques.