Repair of complex transposition of great arteries: What is the best technique to avoid outflow tract obstructions?

OBJECTIVES This study aimed to evaluate the short-/mid-term outcome of patients with complex dextro (d)-/levo (l)-transposition of the great arteries (TGA), ventricular septal defect and left ventricular outflow tract obstructions. METHODS A single-centre, retrospective review of all complex dextro-TGA (n = 85) and levo-TGA (n = 22) patients undergoing different surgeries [Arterial switch operation + left ventricular outflow tract obstruction-resection (ASO-R), half-turned truncal switch/Mair (HTTS), Nikaidoh and Rastelli] between May 1990 and September 2022 was performed. Groups were analysed using Kruskal–Wallis test with post hoc pairwise comparison and Kaplan–Meier time-to-event models. RESULTS A total of 107 patients [ASO-R (n = 20), HTTS (n = 23), Nikaidoh (n = 21), Rastelli (n = 43)] were included, with a median age of 1.0 year (0.5–2.5) and surgical repair median follow-up was 3.8 years (0.3–10.5). Groups did not differ in respect to early postoperative complications/early mortality. Five-year overall survival curves were comparable: ASO-R 78.9% (53.2–91.5), HTTS 75.3% (46.8–89.9), Nikaidoh 85% (60.4–94.9) and Rastelli 83.9% (67.5–92.5), P = 0.9. Highest rates of right ventricular outflow tract (RVOT) reinterventions [33.3% and 32.6% (P = 0.04)] and reoperations [28.6% and 32.6% (P = 0.02)] occurred after Nikaidoh and Rastelli procedures. However, overall freedom from RVOT reinterventions and RVOT reoperations at 5 years did not differ statistically significantly between the groups (ASO-R, HTTS, Nikaidoh and Rastelli): 94.4% (66.6–99.2), 69.1% (25.4–90.5), 67.8% (34–86.9), 64.4% (44.6–78.7), P = 0.2, and 90.0% (65.6–97.4), 91% (50.8–98.7), 65.3% (32.0–85.3) and 67.0% (47.4–80.6), P = 0.3. CONCLUSIONS Surgical repair of complex dextro-/levo-TGA can be performed with satisfying early/mid-term survival. RVOT reinterventions/reoperations were frequent, with highest rates after Nikaidoh and Rastelli procedures. Left ventricular outflow tract obstruction reoperations were rare with zero events after Nikaidoh and HTTS procedures.