Cardiovascular Outcomes After the Arterial Switch Operation for D-Transposition of the Great Arteries

Abstract

Background— Data regarding long-term outcomes after the arterial switch operation for D-transposition of the great arteries are scarce. Methods and Results— A single-institution retrospective cohort study was conducted to assess cardiovascular outcomes after an arterial switch operation between 1983 and 1999. Patients without follow-up visits within 3 years were contacted and secondary sources of information obtained. Overall, 400 patients, 154 (38.3%) with a ventricular septal defect, 238 (59.5%) with an intact septum, and 9 (2.3%) with a Taussig-Bing anomaly, were followed for a median of 18.7 years. In perioperative survivors, overall and arrhythmia-free survival rates at 25 years were 96.7±1.8% and 96.6±0.1%, respectively. Late mortality was predominantly a result of sudden deaths and myocardial infarction. At 25 years, 75.5±2.5% remained free from surgical or catheter-based reintervention. Freedom from an adverse cardiovascular event was 92.9±1.9% at 25 years. Independent predictors were a single right coronary artery (hazard ratio, 4.58; 95% confidence interval, 1.32-15.90), P =0.0166) and postoperative heart failure (hazard ratio, 6.93; 95% confidence interval, 1.57-30.62; P =0.0107). At last follow-up, the left ventricular ejection fraction was 60.3±8.9%, 97.3% had class I symptoms, and 5.2% obstructive coronary artery disease. Peak oxygen uptake was 35.1±7.6 mL/kg/min (86.1±15.1% predicted), with a chronotropic index <80% in 34.2%. At least moderate neoaortic and pulmonary regurgitation were present in 3.4% and 6.6%, respectively, and more than mild neoaortic and pulmonary stenosis in 3.2% and 10.3%. Conclusions— Long-term and arrhythmia-free survival is excellent after arterial switch operation. Although sequelae include chronotropic incompetence and neoaortic, pulmonary, and coronary artery complications, most patients maintain normal systolic function and exercise capacity.

Coronary Artery Problems Late After Arterial Switch Operation for Transposition of the Great Arteries

“…Importantly, none of these coronary abnormalities was detected on history and/or non-invasive studies including ECG and echocardiogram, and only 1 patient had positive screening on EST and MPI (patient 4). Although Khairy et al recently reported a relatively low incidence of late coronary complications after ASO in a larger single-center study, 30 the present results suggest that an occurrence of late coronary events including sudden cardiac death is not insignificant and consistent with the reports by other groups. 18,20,31 Whereas the clinical significance of trivial-mild coronary abnormalities is not entirely clear, some coronary vascular changes may be progressive.…”

Long-Term Outcome of Mustard/Senning Correction for Transposition of the Great Arteries in Sweden and Denmark

“…4 The initial short follow-up showed satisfactory results of ASO in comparison with the Mustard and Senning correction, but long-term results have only recently been reported. [5][6][7][8] The patient population with Mustard and Senning correction is now well into adulthood, making longterm follow-up possible. The population of patients with Mustard and Senning correction represents a clinical challenge and can provide us with important insight into the consequences of having a morphological right ventricle as a systemic ventricle.…”

Late-onset pulmonary arterial hypertension after successful early arterial switch surgery for simple transposition of the great arteries

“…(31) Patients with repaired congenital heart disease and pulmonary vascular disease remain at increased risk of adverse outcome.…”

“…Prior to the availability of targeted therapies, a single-center cohort study showed that the estimated median survival of children and adults with idiopathic pulmonary arterial hypertension were similar (4.12 versus 3.12 years, respectively). (31) Current 5-year survival of idiopathic pulmonary arterial hypertension and pulmonary arterial hypertension associated with congenital heart disease on targeted pulmonary vasodilators are reported to be 71 -75%.…”