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.

中文翻译：

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先天性矫正大动脉转位的解剖学和生理学修复

 背景

先天性校正大动脉转位 （ccTGA） 是一种罕见的心脏异常。管理策略历来包括生理修复，留下形态学右心室来支持体循环。最近，已经实施了解剖修复以将左心室带入体循环。关于哪种修复策略效果最佳，仍然存在不确定性。

 目标

本荟萃分析旨在总结 ccTGA 解剖和生理修复后的长期死亡风险。

 方法

检索了 PubMed、Embase 和 Cochrane 数据库。使用预先指定的数据表格提取数据。主要结局是住院期间以及随访 1 、 5 和 10 年时全因死亡或心脏移植的复合风险。次要结局包括再干预风险。

 结果

共纳入 47 项研究，共 2,844 名患者。解剖和生理修复组的 10 年死亡发生率风险分别为 11.7% （95% CI： 8.5%-15.3%） 和 17.4% （95% CI： 12.4%-23.0%）。10 年时再干预的发生率风险分别为 24.5% （95% CI： 19.2%-30.1%） 和 30.3% （95% CI： 23.5%-37.6%）。在 <5 岁时接受手术且术前有肺动脉束带的解剖修复患者在 10 岁时的主要结局显着降低 （P_异质性 < 0.01）。

 结论

与生理修复相比，ccTGA 患者的解剖修复可导致更高的总生存期和无再干预生存期。具体来说，在 <5 岁时进行解剖修复或术前有肺动脉束带的患者生存率更高。