Anatomic vs physiologic repair of ccTGA: Which leads to better survival?

Anatomic repair of congenitally corrected transposition of the great arteries (ccTGA), a rare cardiac anomaly, improves overall and reintervention-free survival better than physiologic repair, suggests a recent study.

“Specifically, patients who had anatomic repair at <5 years of age or who had preoperative pulmonary artery banding have better survival,” the researchers said.

The research team searched the databases of PubMed, Embase, and Cochrane for relevant studies and extracted data using prespecified forms. The composite risk of all-cause mortality or heart transplantation during hospitalization and at 1, 5, and 10 years of follow-up served as the primary outcome, while reintervention risk was secondary.

Forty-seven studies including 2,844 patients met the eligibility criteria. At 10 years, the incidence risk of mortality was 11.7 percent (95 percent confidence interval [CI], 8.5‒15.3) with anatomic repair and 17.4 percent (95 percent CI, 12.4‒23.0) with physiologic repair.

For reintervention, the incidence risk at 10 years was 24.5 percent (95 percent CI, 19.2‒30.1) with anatomic repair and 30.3 percent (95 percent CI, 23.5‒37.6) with physiologic repair.

In addition, the primary outcome was markedly lower at 10 years among anatomic repair patients who had surgery at <5 years of age and preoperative pulmonary artery banding (p<0.01 for heterogeneity).

“The management strategy historically consisted of physiologic repair, leaving the morphologic right ventricle to support the systemic circulation,” the researchers said. “More recently, anatomic repair has been implemented to bring the left ventricle into the systemic circulation.”