Longitudinal functional health status in young adults with repaired dextro-transposition of the great arteries: A Congenital Heart Surgeons' Society study

Jegatheeswaran, Anusha; Devlin, Paul J.; DeCampli, William M.; Welke, Karl F.; Williams, William G.; Blackstone, Eugene H.; Fuller, Stephanie; Jacobs, Marshall L.; Mussatto, Kathleen A.; Woods, Ronald K.; McCrindle, Brian W.

doi:10.1016/j.jtcvs.2019.07.072

Cited by 10 publications

(33 citation statements)

References 24 publications

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“…We live today in the era of 2% operative mortality associated with the arterial switch operation. 3 And, as reported by Jegatheeswaran and colleagues, 1 the parents today are led to expect normal perception of health and functional outcomes out to 20 years of follow-up. The study included 868 patients who met the eligibility criteria for the study.…”

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confidence: 91%

“…Medical literature, with a similar bias, is written for the survivors. In this issue of the Journal, Jegatheeswaran and colleagues 1 write about the outcome of a story that started in 1976, when Jatene and colleagues 2 reported the first survivor of the arterial switch operation for transposition of the great arteries. We live today in the era of 2% operative mortality associated with the arterial switch operation.…”

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confidence: 99%

“…It is an operation that is as artistic as it is unforgiving. To get a sense of how real this story is, you need not look beyond the rather carefully worded sentence in the article of Jegatheeswaran and colleagues 1 where they state, ''At the time of SF-36 administration (January 2010-October 2010), 659 of the 868 patients were not known to be dead.'' That is to say, the rest of the patients-209, or 24%-are known to be dead.…”

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confidence: 99%

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Commentary: Heroes of the arterial switch operation in the 1980s

Al‐Radi

2020

The Journal of Thoracic and Cardiovascular Surgery

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confidence: 91%

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confidence: 99%

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confidence: 99%

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Commentary: Heroes of the arterial switch operation in the 1980s

Al‐Radi

2020

The Journal of Thoracic and Cardiovascular Surgery

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“…Surgical results with low perioperative mortality over the last decades have now led to focus on the long-term outcomes. Health condition and quality-of-life assessments recently showed that most adult patients perceive normal functional health status, similar to healthy peers [ 1 ]. Cardiovascular outcome and survival from mid- and long-term follow-up studies are based on data from 20- up to 30-year post-ASO.…”

Section: Introductionmentioning

confidence: 99%

Long-term outcome after the arterial switch operation: 43 years of experience

Palen

Blom

Kuipers

et al. 2021

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES The objective of this study was to assess our 43-year experience with arterial switch operation (ASO) for transposition of the great arteries (TGA) by analysing cardiac outcome measures (hospital and late mortality, reoperations and catheter interventions, significant coronary artery obstruction) and to identify risk factors for reoperation and catheter interventions. METHODS A total of 490 patients who underwent ASO for TGA from 1977 to 2020 were included in this retrospective, single-centre study. Data on reoperation and catheter intervention of hospital survivors were estimated by the Kaplan–Meier method and compared using a long-rank test. Risk factors for reoperation and/or catheter intervention were assessed by multivariate Cox regression analysis. RESULTS Hospital mortality occurred in 43 patients (8.8%), late death in 12 patients (2.9%) and 43 patients were lost to follow-up. Median follow-up time of 413 hospital survivors was 15.6 (interquartile range 7.0–22.4) years. Reoperations were performed in 83 patients (117 reoperations). Neoaortic valve regurgitation with root dilatation was the second most common indication for reoperation (15/83 patients, 18.1%) after right ventricular outflow tract obstruction (50/83 patients, 60.2%). Risk factors for any reoperation on multivariable analysis were: TGA morphological subtype [TGA with ventricular septal defect: hazard ratio (HR) = 1.99, 95% confidence interval (CI) 1.18–3.36; P = 0.010 and Taussig-Bing: HR = 2.17, 95% CI 1.02–4.64; P = 0.045], aortic arch repair associated with ASO (HR = 3.03, 95% CI 1.62–5.69; P = 0.001) and a non-usual coronary artery anatomy (HR = 2.41, 95% CI 1.45–4.00; P = 0.001). One hundred and one catheter interventions were performed in 54 patients, usually for relief of supravalvular pulmonary stenosis (44/54 patients, 81.5%) or arch obstruction (10/54 patients, 18.5%). Main risk factor for catheter intervention on multivariable analysis was aortic arch repair associated with ASO (HR = 2.95, 95% CI 1.37–6.36; P = 0.006). Significant coronary artery stenosis was relatively uncommon (9/413 patients, 2.2%) but may be underrepresented. CONCLUSIONS Patients after ASO typically have good long-term clinical outcomes but reoperations and interventions remain necessary in some patients. Neoaortic valve regurgitation with root dilatation is the second most common indication for reoperation after right ventricular outflow tract obstruction and an increasing need for neoaortic valve and root redo surgery in future is to be expected.

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“…As evidenced by Jegatheeswaran and colleagues, postoperative patients with d-TGA can reasonably anticipate a normal FHS as they transition into adulthood. 3 The outcomes for patients with CHD consist of more than just M&Ms; they must include FHS. The self-perceived decline in general health status and physical functioning is likely multifactorial.…”

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confidence: 99%