[Anatomic correction of transposition of the great arteries: a model of surgical "cure" in pediatric cardiology?].

Transposition of the great arteries (TGA) is a common congenital heart malformation, involving inversion of the two great vessels (aorta and pulmonary artery). Without surgical treatment, TGA is not compatible with life. The prognosis of this malformation has been dramatically changed by the development of neonatal cardiac surgery. "Anatomic" repair was introduced in the 1980s, with the goal of providing near-normal cardiac anatomy. It is carried out in neonates with isolated TGA (so-called simple TGA), as well as in those with associated anomalies (ventricular septal defect, aortic coarctation). Since January 1987, 1020 neonates have undergone anatomic repair of TGA in the pediatric cardiac surgery department of Groupe Hospitalier Laennec-Necker-Enfants Malades in Paris. The overall mortality rate was 4.8% (49 patients), and all deaths occurred within the first postoperative year. Among the 966 survivors who could be monitored (mean follow-up 6.2 years), 52 children (5.4%) underwent reoperation, with no additional mortality. Nearly all the survivors have normal cardiac function and quality of life. Despite significant mortality (albeit currently low) anda low risk of reoperation, the mid-term results of anatomic repair of TGA are excellent and represent a surgical "cure" in most cases. Very-long-term outcome remains to be determined.