Surgical outcomes of anatomic repair in congenitally corrected Transposition of the Great Arteries: a 28-Year, Multicentre Dutch experience

OBJECTIVES Anatomic repair is the contemporary preferred management strategy for congenitally corrected transposition of the great arteries (ccTGA). Most outcome data derive from small single-centre series. This study aims to review long-term outcomes of surgical treatment in a multicentre cohort of ccTGA patients in the Netherlands over a 28-year period. METHODS All patients with ccTGA undergoing anatomic repair (double switch repair, arterial switch operation with hemi-Mustard/bidirectional Glenn, or Rastelli/Nikaidoh with Mustard or hemi-Mustard/bidirectional Glenn) between 1997 and 2025 were retrospectively analyzed. RESULTS Sixty-two patients underwent anatomic repair at a median age of 2.5 (IQR 1.4–4.0) years. Overall hospital mortality was 6.5%, decreasing to 1.9% after 2006. At a median follow-up of 11.9 years, 20-year survival exceeded 80%. Reoperation was required in 31%, most often for conduit replacement after Rastelli/Nikaidoh, baffle obstruction or neoaortic valve/root disease after double switch, and least after the arterial switch with hemi-Mustard/bidirectional Glenn (11.7%). Percutaneous interventions were performed in 16%. Complete atrioventricular block requiring pacemaker implantation occurred in one-third, while late atrial arrhythmias were infrequent (<10%). At latest follow-up, systemic left ventricular function was preserved in most patients, with only 2 patients showing moderate dysfunction. CONCLUSIONS After an initial learning curve, anatomic ccTGA repair has low operative mortality, good long-term survival, and preserved systemic left ventricular function in the majority of patients. Reintervention rates are considerable.