Outcomes After Anatomic Versus Physiologic Repair of Congenitally Corrected Transposition of the Great Arteries: A Systematic Review and Meta-Analysis

World J Pediatr Congenit Heart Surg. 2023 Jan;14(1):70-76. doi: 10.1177/21501351221127894.


Surgical treatment for congenitally corrected transposition of the great arteries is widely debated, with both physiologic repair and anatomic repair holding advantages and disadvantages. This meta-analysis, which includes 44 total studies consisting of 1857 patients, compares mortality at different time points (operative, in-hospital, and post-discharge), reoperation rates, and postoperative ventricular dysfunction between these two categories of procedures. Although anatomic and physiologic repair had similar operative and in-hospital mortality, anatomic repair patients had significantly less post-discharge mortality (6.1% vs 9.7%; P = .006), lower reoperation rates (17.9% vs 20.6%; P < .001), and less postoperative ventricular dysfunction (16% vs 43%; P < .001). When anatomic repair patients were subdivided into those who had atrial and arterial switch versus those who had atrial switch with Rastelli, the double switch group had significantly lower in-hospital mortality (4.3% vs 7.6%; P = .026) and reoperation rates (15.6% vs 25.9%; P < .001). The results of this meta-analysis suggest a protective benefit of favoring anatomic repair over physiologic repair.

Keywords: congenital heart disease; congenital heart surgery; hypoplastic left heart syndrome; meta-analysis; statistics.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Review

MeSH terms

  • Aftercare
  • Atrial Fibrillation*
  • Congenitally Corrected Transposition of the Great Arteries
  • Humans
  • Patient Discharge
  • Transposition of Great Vessels* / surgery