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
Processing time: 146 Days and 8.4 Hours
ARTICLE HIGHLIGHTS
Research background

Anatomic repair for congenitally corrected transposition of great arteries (cc-TGA) is accomplished by either a double switch operation or one of many modifications of an atrial switch operation combined with a Rastelli operation. However, these operations are complex and a simpler physiologic repair strategy of correcting only associated defects like tricuspid valve regurgitation or ventricular septal defects is also adopted in many patients. Anatomic repair strategy has the benefit of restoring the left ventricle to the systemic circulation, thus decreasing the chances of development of congestive heart failure from a systemic right ventricle.

Research motivation

There are variations in practice regarding anatomic versus physiologic repair for cc-TGA. Long term data from a large set of patients regarding safety and outcomes of anatomic repair are lacking.

Research objectives

The objective of this study was to pool high quality observational studies reporting outcomes after anatomic repair in cc-TGA patients and perform a systematic review and meta-analysis to provide more comprehensive outcomes.

Research methods

A search of MEDLINE and Scopus was conducted using pre-defined search criteria to identify manuscripts reporting outcomes after anatomic repair. Studies meeting inclusion criteria were reviewed and information regarding variables of interest were extracted. Meta-analysis was performed according to standard methods using Comprehensive meta-analysis software (version 3).

Research results

Eight hundred and ninety-five patients who were treated with an anatomic repair strategy were pooled from 21 studies with a total follow-up of 5457.2 patient-years (PY). Estimated operative mortality was 8.3%. Survivors had a transplant free survival of 92.5% (CI: 89.5%-95.4%) per 100 PY. 84.7% patients experienced a New York Heart Association functional class I or II after 100 PY follow up. There were 5.3 re-operations/re-interventions per 100 PY (CI: 3.8-6.8).

Research conclusions

Our study reports a high operative mortality rate for anatomic repair strategy in cc-TGA patients. However, the long-term survival is excellent for survivors.

Research perspectives

Our study suggests that the anatomic repair is worth pursuing in most patients with cc-TGA because of favorable long-term outcomes despite a high operative mortality risk. Re-intervention/reoperation risk remains – however with the advent of transcatheter therapies, most of these issues can be managed without a re-operation in the modern era.