Long-Term Outcomes After Atrial Switch Operation for Transposition of the Great Arteries.
Journal of the American College of Cardiology
washington; spokane; Adult; QRS duration; atrial arrhythmia; congenital heart disease; congestive heart failure; systemic right ventricle; transposition of the great arteries; Arterial Switch Operation; Arteries; Female; Follow-Up Studies; Heart Failure; Humans; Male; Retrospective Studies; Transposition of Great Vessels; Treatment Outcome
BACKGROUND: For patients with d-loop transposition of the great arteries (d-TGA) with a systemic right ventricle after an atrial switch operation, there is a need to identify risks for end-stage heart failure outcomes.
OBJECTIVES: The authors aimed to determine factors associated with survival in a large cohort of such individuals.
METHODS: This multicenter, retrospective cohort study included adults with d-TGA and prior atrial switch surgery seen at a congenital heart center. Clinical data from initial and most recent visits were obtained. The composite primary outcome was death, transplantation, or mechanical circulatory support (MCS).
RESULTS: From 1,168 patients (38% female, age at first visit 29 ± 7.2 years) during a median 9.2 years of follow-up, 91 (8.8% per 10 person-years) met the outcome (66 deaths, 19 transplantations, 6 MCS). Patients experiencing sudden/arrhythmic death were younger than those dying of other causes (32.6 ± 6.4 years vs 42.4 ± 6.8 years; P < 0.001). There was a long duration between sentinel clinical events and end-stage heart failure. Age, atrial arrhythmia, pacemaker, biventricular enlargement, systolic dysfunction, and tricuspid regurgitation were all associated with the primary outcome. Independent 5-year predictors of primary outcome were prior ventricular arrhythmia, heart failure admission, complex anatomy, QRS duration >120 ms, and severe right ventricle dysfunction based on echocardiography.
CONCLUSIONS: For most adults with d-TGA after atrial switch, progress to end-stage heart failure or death is slow. A simplified prediction score for 5-year adverse outcome is derived to help identify those at greatest risk.
Broberg, Craig S; van Dissel, Alexandra; Minnier, Jessica; Aboulhosn, Jamil; Kauling, Robert M; Ginde, Salil; Krieger, Eric V; Rodriguez, Fred; Gupta, Tripti; Shah, Sangeeta; John, Anitha S; Cotts, Timothy; Kay, W Aaron; Kuo, Marissa; Dwight, Cindy; Woods, Patricia; Nicolarsen, Jeremy; Sarubbi, Berardo; Fusco, Flavia; Antonova, Petra; Fernandes, Susan; Grewal, Jasmine; Cramer, Jonathan; Khairy, Paul; Gallego, Pastora; O'Donnell, Clare; Hannah, Jane; Dellborg, Mikael; Rodriguez-Monserrate, Carla P; Muhll, Isabelle Vonder; Pylypchuk, Stephen; Magalski, Anthony; Han, Frank; Lubert, Adam M; Kay, Joseph; Yeung, Elizabeth; Roos-Hesselink, Jolien; Baker, David; Celermajer, David S; Burchill, Luke J; Wilson, William M; Wong, Joshua; Kutty, Shelby; and Opotowsky, Alexander R, "Long-Term Outcomes After Atrial Switch Operation for Transposition of the Great Arteries." (2022). Articles, Abstracts, and Reports. 6546.