Meta-Analysis
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Aug 26, 2020; 12(8): 427-436
Published online Aug 26, 2020. doi: 10.4330/wjc.v12.i8.427
Systematic review and meta-analysis of outcomes of anatomic repair in congenitally corrected transposition of great arteries
Arka Chatterjee, Neal J Miller, Marc G Cribbs, Amrita Mukherjee, Mark A Law
Arka Chatterjee, Neal J Miller, Marc G Cribbs, Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL 35294, United States
Marc G Cribbs, Mark A Law, Department of Pediatric Cardiology, University of Alabama at Birmingham, Birmingham, AL 35294, United States
Amrita Mukherjee, Department of Epidemiology, University of Alabama at Birmingham School of Public health, Birmingham, AL 35233, United States
Author contributions: Chatterjee A and Law MA contributed to overall conception of study objectives, data acquisition and final approval, data analysis, manuscript preparation and approval; Miller NJ and Cribbs MG contributed to data acquisition; Mukherjee A contributed to data analysis and statistical review; all authors have read and approve the final manuscript.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: PRISMA guidelines were followed in reporting this meta-analysis.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Arka Chatterjee, MD, Assistant Professor; Division of Cardiovascular Disease, University of Alabama at Birmingham, 510 20th St S FOT 920, Birmingham, AL 35294, United States. arkachatterjee2608@gmail.com
Received: March 24, 2020
Peer-review started: March 24, 2020
First decision: April 26, 2020
Revised: June 8, 2020
Accepted: July 19, 2020
Article in press: July 19, 2020
Published online: August 26, 2020
Abstract
BACKGROUND

Treatment of congenitally corrected transposition of great arteries (cc-TGA) with anatomic repair strategy has been considered superior due to restoration of the morphologic left ventricle in the systemic circulation. However, data on long term outcomes are limited to single center reports and include small sample sizes.

AIM

To perform a systematic review and meta-analysis for observational studies reporting outcomes on anatomic repair for cc-TGA.

METHODS

MEDLINE and Scopus databases were queried using predefined criteria for reports published till December 31, 2017. Studies reporting anatomic repair of minimum 5 cc-TGA patients with at least a 2 year follow up were included. Meta-analysis was performed using Comprehensive meta-analysis v3.0 software.

RESULTS

Eight hundred and ninety-five patients underwent anatomic repair with a pooled follow-up of 5457.2 patient-years (PY). Pooled estimate for operative mortality was 8.3% [95% confidence interval (CI): 6.0%-11.4%]. 0.2% (CI: 0.1%-0.4%) patients required mechanical circulatory support postoperatively and 1.7% (CI: 1.1%-2.4%) developed post-operative atrioventricular block requiring a pacemaker. Patients surviving initial surgery had a transplant free survival of 92.5% (CI: 89.5%-95.4%) per 100 PY and a low rate of need for pacemaker (0.3/100 PY; CI: 0.1-0.4). 84.7% patients (CI: 79.6%-89.9%) were found to be in New York Heart Association (NYHA) functional class I or II after 100 PY follow up. Total re-intervention rate was 5.3 per 100 PY (CI: 3.8-6.8).

CONCLUSION

Operative mortality with anatomic repair strategy for cc-TGA is high. Despite that, transplant free survival after anatomic repair for cc-TGA patients is highly favorable. Majority of patients maintain NYHA I/II functional class. However, monitoring for burden of re-interventions specific for operation type is very essential.

Keywords: Congenitally corrected transposition of great arteries, Anatomic repair, Double switch operation, Atrial switch Rastelli, Hemi-Mustard Rastelli, Atrio-ventricular block

Core tip: This is a systematic review and meta-analysis looking at short- and long-term outcomes with the anatomic repair strategy (double switch or atrial switch Rastelli operation) for patients with congenitally corrected transposition of great arteries. Updated outcomes of operative mortality, long term survival free of transplantation and re-operation/re-intervention rates are provided. We find favorable long-term survival after anatomic repair despite the initial high operative mortality.