Anatomic and Physiologic Repair of Congenitally Corrected Transposition of the Great Arteries

Background: Congenitally corrected transposition of the great arteries (ccTGA) is a rare cardiac anomaly. The management strategy historically consisted of physiologic repair, leaving the morphologic right ventricle to support the systemic circulation. More recently, anatomic repair has been implemented to bring the left ventricle into the systemic circulation. Uncertainty persists about which repair strategy has the best outcome. Objectives: This meta-analysis aimed to summarize the long-term mortality risks following anatomic and physiologic repair of ccTGA. Methods: PubMed, Embase, and the Cochrane Database were searched. Data were extracted using prespecified data forms. The primary outcome was the composite risk of all-cause mortality or heart transplantation during hospitalization and at 1, 5, and 10 years of follow-up. Secondary outcomes included reintervention risk. Results: Forty-seven studies totaling 2,844 patients were included. The incidence risk of mortality at 10 years was 11.7% (95% CI: 8.5%-15.3%) and 17.4% (95% CI: 12.4%-23.0%) in the anatomic and physiologic repair groups, respectively. The incidence risk of reintervention at 10 years was 24.5% (95% CI: 19.2%-30.1%) and 30.3% (95% CI: 23.5%-37.6%), respectively. The primary outcome was significantly lower at 10 years in anatomically repaired patients who had surgery at <5 years of age and who had preoperative pulmonary artery banding (P_{heterogeneity} < 0.01). Conclusions: Anatomic repair of ccTGA patients results in higher overall and reintervention-free survival compared to physiologic repair. Specifically, patients who had anatomic repair at <5 years of age or who had preoperative pulmonary artery banding have better survival.