Long-term Result of Anatomical Repair for Discordant Atrioventricular Connections: Comparison of Anatomical and Physiological Repair

  • Takeshi Konuma, Tokyo Women’s Medical University Divisions of Cardiovascular Surgery, Japan
  • Yasuharu Imai, Tokyo Women’s Medical University Divisions of Cardiovascular Surgery, Japan
  • Kohta Agematsu, Japan
  • Kiyotaka Yano, Japan
  • Dr Masaki Sasoh, Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical University, Japan
  • Prof Toshio Nakanishi, Tokyo Women's Medical University, Pediatric Cardiology, Japan
  • Prof Hiromi Kurosawa, Tokyo Women's Medical University, Cardiovascular Surgery, Japan

    • Background: Anatomical repair (Double-Switch operation) is expected to have improved long term result by using morphological left ventricle and mitral valve in the systemic circulation compared to conventional repair for discordant atrioventricular connections, but longer-term impact remains unknown. In this study we reviewed the late result of various type procedures and analyzed the risk factor, mortality and reintervention.
    Methods: Since 1972, a total of 207 patients with discordant atrioventricular connections (l-TGA) underwent surgical repair and we excluded single ventricle patients in this study. Conventional repair was 55 patients (including 31 conventional Rastelli patients) (group I), Fontan type procedure were 43 patients (group II), Double-Switch operation were 90 patients (group III). Furthermore in group III, we compared 72 patients who had Rastelli procedure (group A) and 18 patients underwent arterial switch (group B).
    Results: The Kaplan-Meier estimated survival rates at 20 years was 70% in group I, 86% in group II, and 79% in group III (p=0.26). Freedom from reintervention was 49% in group I, 52% in group II, and 43% in group III (p=0.03). In Double-Switch operation, survival ratio was 78% in group A, 81% in group B (p=0.84), and Freedom from reintervention was 37% in group A, 74% in group B (p=0.05).
    Conclusion: There were no significant differences between groups in survival ratio, but tricuspid regurgitation was risk factor for conventional repair. In Double-Switch procedure, combination of Rastelli and atrial switch procedure was risk factor for reintervention, but mortality was same to the group of arterial and atrial switch.