European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2026
Comparative Long-Term Outcomes of Anatomical and Physiological Repair for Corrected Transposition.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Tominaga Yuji, Takeshita Masashi, Watanabe Takuji, Shibagaki Keisuke, Nakamizo Masaya, Kurosaki Kenichi, Shiraishi Isao, Iwai Shigemitsu
Аннотация
OBJECTIVES: The optimal surgical strategy for congenitally corrected transposition of the great arteries (ccTGA) remains debated. This study aimed to compare the long-term outcomes of each surgical approach and to explore the optimal management strategy.
METHODS: We retrospectively reviewed 107 consecutive patients with ccTGA who underwent biventricular repair at our institution between 1978 and 2023. Patients were categorized into 4 groups: atrial switch with arterial switch (AR-A, n = 17), atrial switch with Rastelli (AR-R, n = 59), physiological repair with Rastelli (PR-R, n = 17), and physiological repair with a native pulmonary valve (PR-N, n = 14). The primary end-point was all-cause mortality. Secondary end-points included reoperation, heart failure, arrhythmia, and pacemaker implantation.
RESULTS: Median follow-up was 16 years (IQR, 5.2-25). Twenty-year survival did not differ between anatomical and physiological repair (79% vs 82%, P = .97). Among the 4 groups, survival was 94% (AR-A), 75% (AR-R), 86% (PR-R), and 77% (PR-N). Reoperation-free survival was lowest in PR-R (29%) and significantly lower in Rastelli-type repairs (P = .009). Heart failure occurred more often in Rastelli groups. AR-A achieved the most favourable functional outcomes, with preserved systemic ventricular function, the highest maximum oxygen uptake (37 mL/kg/minute), and the lowest brain natriuretic peptide (13 pg/mL).
CONCLUSIONS: In this 40-year experience, survival after physiological repair was comparable to anatomical repair. However, AR-A yielded the most favourable long-term functional outcomes and should be considered the preferred strategy when anatomically feasible. Rastelli-type repairs were associated with increased reoperation and heart failure, underscoring the need for refinement of systemic ventricle outflow tract reconstruction techniques.
METHODS: We retrospectively reviewed 107 consecutive patients with ccTGA who underwent biventricular repair at our institution between 1978 and 2023. Patients were categorized into 4 groups: atrial switch with arterial switch (AR-A, n = 17), atrial switch with Rastelli (AR-R, n = 59), physiological repair with Rastelli (PR-R, n = 17), and physiological repair with a native pulmonary valve (PR-N, n = 14). The primary end-point was all-cause mortality. Secondary end-points included reoperation, heart failure, arrhythmia, and pacemaker implantation.
RESULTS: Median follow-up was 16 years (IQR, 5.2-25). Twenty-year survival did not differ between anatomical and physiological repair (79% vs 82%, P = .97). Among the 4 groups, survival was 94% (AR-A), 75% (AR-R), 86% (PR-R), and 77% (PR-N). Reoperation-free survival was lowest in PR-R (29%) and significantly lower in Rastelli-type repairs (P = .009). Heart failure occurred more often in Rastelli groups. AR-A achieved the most favourable functional outcomes, with preserved systemic ventricular function, the highest maximum oxygen uptake (37 mL/kg/minute), and the lowest brain natriuretic peptide (13 pg/mL).
CONCLUSIONS: In this 40-year experience, survival after physiological repair was comparable to anatomical repair. However, AR-A yielded the most favourable long-term functional outcomes and should be considered the preferred strategy when anatomically feasible. Rastelli-type repairs were associated with increased reoperation and heart failure, underscoring the need for refinement of systemic ventricle outflow tract reconstruction techniques.