Systemic atrioventricular valve surgery works in patients with ccTGA

Patients with congenitally corrected transposition of the great vessels (ccTGA) may benefit from undergoing systemic atrioventricular valve (SAVV) surgery, which results in low early mortality and satisfactory long-term outcomes, suggests a study.

A retrospective review was carried out in 108 ccTGA patients (median age 39.5 years) undergoing SAVV surgery from 1979 to 2022. A composite endpoint of mortality, cardiac transplantation, or ventricular assist device implantation served as the primary endpoint, while long-term systemic right ventricular ejection fraction (SVEF) was secondary.

The investigators analysed the survival and late SVEF data using Cox proportional hazard and linear regression models.

The median preoperative SVEF was 39 percent. The most common mechanism of SAVV regurgitation was intrinsic valve abnormality (76.9 percent). Of the patients, only one had early postoperative death (0.9 percent). The actuarial freedom from death or transplantation was 92.4 percent at 5 years, 79.1 percent at 10 years, and 62.9 percent at 20 years.

Freedom from valve reoperation was 100 percent at 10 years and 93 percent at 20 years for mechanical prosthesis. For bioprosthesis, the corresponding rates were much lower at 56.6 percent and 15.7 percent (p<0.0001).

Postoperative mortality was significantly associated with age at operation (p=0.01) and preoperative SVEF (p=0.04). In addition, preoperative SVEF (p<0.001), complex ccTGA (p=0.02), severe SAVV regurgitation (p=0.04), and preoperative creatinine (p=0.003) predicted late postoperative SVEF.

“Timely referral and accurate patient selection are the keys to better long-term outcomes,” the investigators said.