Anatomic repair of transposition of the great arteries

Transposition of the great arteries (TGA) covers a wide range of anatomic v ariants involving not only the origin of the great arteries, but the intrac ardiac structures and the aortic arch. TGA can now benefit from complete an atomic repair, namely switch operation, performed in simple forms during th e neonatal period Accurate pre and intraoperative assessment must take into account the main anatomic features: relationship between the aorta and the pulmonary artery and coronary arteries distribution. Over the last sixteen years, 1 063 patients with TGA underwent anatomic repair in our institutio n. Among 728 patients with simple TGA, 92 % were operated on within the fir st 2 weeks of life. Among 335 patients with complex TGA, all had a large VS D and 154 had additional anomalies. Among these 335 patients, 264 had one-s tage complete repair. and 71 had two-stage repair, at the beginning of our experience. In complex forms the main associated anomalies involved the ven tricles (right ventricle hypoplasia (II), malaligned VSD (90), restrictive VSD (3), multiple VSD (43)), the atrioventricular valves (straddling of the mitral or tricuspid valve (15), mitral valve anomalies (cleft or tissue ta g. 4) mid the aortic arch (coarctation [88], interrupted aortic arch (8)). The hospital mortality was 6.9 % for simple TGA, 14.6 % for complex TGA. Ma in causes of early death were failure in coronary artery relocation and pul monary hypertensive crisis, Mean follow-up (95.5 % of patients) was 49 mont hs. Overall 16-year survival was 87.9 %, 91,5 % for simple forms and 80.4 % for complex forms Anatomic repair is nowadays the treatment of choice for TGA. Long-term results will depend on the evolution of the relocated corona ry arteries and of the neo-aortic valve.