Comparison of long-term outcomes of atrial switch with Rastelli and physiological repair using left ventricle-to-pulmonary artery conduit for levo-transposition of the great arteries

Objectives: The objectives of this study was to compare the long-term outcomes of anatomic repair using atrial switch with the Rastelli procedure versus physiolog-ical repair with left ventricle-to-pulmonary artery conduit for patients with levo-transposition of the great arteries, ventricular septal defect, and left ventricular outflow tract obstruction.Methods: Of patients with levo-transposition of the great arteries who underwent biventricular repair between 1978 and 2001, 31 hospital survivors after anatomic repair of atrial switch and the Rastelli (anatomic group) and 14 hospital survivors after physiological repair with left ventricle-to-pulmonary artery conduit (physio-logical group) were enrolled. Survival rates, reoperation rates, and most recent con-ditions were compared.Results: The overall survival rate at 20 years was 79.7% (95% CI, 66.4%-95.6%) in the anatomic group and 85.1% (95% CI, 68.0%-100%) in the physiological group (P = .87). The reoperation rate at 10 years was 19.8% (95% CI, 5.6%-34.0%) in the anatomic group and 52.0% (95% CI, 25.0%-79.1%) in the physiological group (P = .067). Only patients in the physiological group underwent systemic tricuspid valve replacement. The anatomic group showed a better cardiac index at catheterization (2.79 +/- 0.75 L/min/m2 vs 2.30 +/- 0.54 L/min/m2; P = .035), lower serum brain natri-uretic peptide (73 +/- 86 pg/mL vs 163 +/- 171 pg/mL; P = .024), and better maximal oxygen uptake in the treadmill test (64.1 +/- 16.5% vs 52.7 +/- 17.8% of predicted normal; P = .036), although the period until most recent catheterization, blood in-spection, and treadmill testing were earlier in the anatomic group.Conclusions: Preservation of the left ventricle as the systemic ventricle using anatomic repair contributes to better cardiopulmonary condition compared with physiological repair. (J Thorac Cardiovasc Surg 2023;165:1205-15)