Outcomes of Heart Transplantation in Adults With Transposition of the Great Arteries: A Single-Center Experience

BackgroundTransposition of the great arteries (TGA) is a congenital heart disease characterized by ventriculoarterial discordance. Corrective surgeries can provide long-term palliation, but many patients ultimately develop systemic right ventricular failure and end-stage heart failure. Heart transplantation (HT) is an established treatment in adults with congenital heart disease, but data specifically focused on adults with TGA undergoing HT remains limited, with only small single-center series reported to date. The aim of this study was to describe perioperative complexity, immunologic burden, and posttransplant outcomes in adults with TGA undergoing HT.MethodsIn this retrospective study, 9 consecutive adult TGA patients received HT between January 2019 and December 2025. Pre-listing assessment by a multidisciplinary team and operative and postoperative details were recorded. The primary endpoint was overall survival; secondary endpoints included need for mechanical circulatory support (MCS) and acute rejection.ResultsMedian recipient age was 45 (43-52) years; 55.6% (5/9) were women. Median waiting time was 98.0 (62.2-140.5) days. Median ischemia and cardiopulmonary bypass times were 240 (195-272) and 191 (145-220) minutes, respectively. One of 9 patients (11.1%) required postoperative MCS. Median follow-up time was 4.0 (0.8-5.3) years, with a survival rate of 88.9% (8/9) during the follow-up period and 1 in-hospital death. Four of 9 patients (44.4%) developed acute rejection, and all were successfully managed.ConclusionsHeart transplantation is a feasible and life-extending strategy for patients with TGA who develop heart failure despite prior palliative interventions. Multidisciplinary assessment and surgical expertise are crucial for optimizing outcomes. This study highlights the challenges of HT in this disease.