A Survey of Pediatric Cardiologists and Cardiac Surgeons on the Care of Congenitally Corrected Transposition of the Great Arteries (L-TGA)

Background: Due to its rarity and the diversity of associated lesions, the standard of care for congenitally corrected transposition of the great arteries (L-TGA) is controversial.

Methods: We sent an online survey regarding treatment of L-TGA. to the AAP Section on Cardiology and Cardiac Surgery, the Pediheart online community, and the congenital heart surgeon members of The Society for Thoracic Surgery. The survey asked for treatment recommendations for six variations of L-TGA at ages <2, 2-15 and >15 years of age.

Results: We received responses from 81 pediatric cardiologists, 52 congenital heart surgeons, and 8 other cardiovascular professionals.

Although infrequently recommended overall, an anatomical repair or double switch (DS) procedure was more often recommended in younger patients with more complex disease. In most scenarios, cardiac surgeons were more likely to recommend a DS procedures than cardiologists.

In L-TGA patients with mild tricuspid regurgitation as the only associated lesion, less than ¼ of respondents would lean toward or recommend a DS procedure. However, cardiac surgeons were more likely to recommend DS than cardiologists when these patients were less than 2 years (p=.009) and 2-15 years old (p=.013).

Additionally, professionals from institutions which perform DS procedures were more likely to recommend them.

With regard to their clinical care in L-TGA, 7.2% felt cardiologists were more likely to recommend anatomic repair than surgeons, 28.7% felt surgeons were more likely to recommend anatomic repair than cardiologists.

Additionally, with regards to their treatment recommendations for patients with L-TGA, 8.1% felt extremely comfortable, 53.2% felt somewhat comfortable, 27.9% were neither comfortable nor uncomfortable, 14.4% were somewhat uncomfortable and 6.3% were extremely uncomfortable.

Conclusion: This survey demonstrates physician discomfort as well as a wide range of recommendations for patients with L-TGA underscoring the limited data on best practices for L-TGA. Although anatomic repair carries a theoretical advantage, professionals who manage these patients appear to recommend them in a minority of clinical scenarios.