Long-Term Outcome After the En Bloc Rotation of the Outflow Tracts Including Patients With Congenitally Corrected Transposition of the Great Arteries

OBJECTIVES: Despite the increasing use of the en bloc rotation of the outflow tracts to treat patients with transposition of the great arteries with left ventricular outflow tract obstruction, long-term outcome data are scarce. Cases with simultaneous Mustard operation are a challenging technical expansion. This retrospective study aims to evaluate long-term outcomes in a single-centre cohort. METHODS: All patients undergoing the en bloc rotation at the Children's Heart Center Linz between 2003 and 2024 were retrospectively analysed. RESULTS: The en bloc rotation was performed in 38 patients. Median age at operation was 4.1 (0.7; 23.9) months, weight 5.4 (3.7; 9.6) kg. A congenitally corrected transposition was present in 3 patients, in which a simultaneous Mustard procedure was performed. Median cardiopulmonary bypass time was 291 (270; 353) minutes, aortic cross-clamp time 160 (142; 185) minutes. The pulmonary valve could be preserved in 24 children (63%). Two patients died during the hospital stay (5%). During a follow-up period of median 9.3 (4.4; 14.3) years, 3 further children deceased, 5 surgical reinterventions were necessary. There was no death or surgical reintervention in the congenitally corrected transposition group. CONCLUSIONS: The long-term outcome of the en bloc rotation is very promising, as could be expected due to the anatomic repair with growth potential in all tubular structures. The increased experience also with the Mustard operation allowed the combination of both complex procedures with excellent short-term outcome. CLINICAL REGISTRATION NUMBER: EK Nr 1011/2025, Ethics committee of the Medical Faculty at the Johannes Kepler University Linz.