Predictors of mortality after atrial correction of transposition of the great arteries

Abstract

ObjectivesTo determine the long-term and transplantation-free survival of all patients after atrial correction of transposition of the great arteries (TGA) in the Czech and Slovak republics, including its preoperative and perioperative determinants.MethodsRetrospective analysis of all 454 consecutive patients after atrial correction of TGA was performed. Of these, 126 (27.8%) were female, median age at operation was 7.4 months (Q1 5.3; Q3 13.3) and 164 (36.1%) underwent the Mustard procedure. The relationships between age, weight, the complexity of TGA, operative technique, additional surgical procedures, immediate postoperative presence of tricuspid regurgitation and revision procedures during follow-up to major composite outcome, as such defined as long-term and transplantation-free survival, were tested.ResultsEarly 30-day mortality did not differ between the Mustard (9.76%) and Senning (8.97%) cohorts (p=0.866). The long-term and transplantation-free survival, which differed between the Mustard and Senning cohorts in favour of the Senning procedure (HR 0.43; 95% CI 0.21 to 0.87), was shorter in complex TGA (HR 2.4; 95% CI 1.59 to 3.78) and in complex surgical interventions (HR 3.51; 95% CI 2.31 to 5.56). The immediate presence of at least moderate tricuspid regurgitation after correction was associated with a shorter long-term and transplantation-free survival in the univariate but not in the multivariable model.ConclusionsThe lower long-term survival of patients after an atrial switch operation of TGA in the Czech and Slovak republics is associated with greater complexity of TGA, complex surgical interventions and application of the the Mustard operative procedure.

Fate After the Mustard Procedure for d-Transposition of the Great Arteries: Impact of Age, Complexity, and Atrial Tachyarrhythmias: A Single Center Experience

“…Patients with complex congenital heart disease > 30 years of age have been reported to be at a constantly growing risk for fatal outcome [ 11 ]. The additional burden of associated malformations in subjects with complex d-TGA probably played a pivotal role determining long-term outcome as this subgroup had higher mortality and shorter survival during follow-up as previously reported [ 12 ]. The burden of additional surgery like VSD closure or coarctation repair might well be one reason for worse outcome.…”

Heart failure in systemic right ventricle: Mechanisms and therapeutic options

“…Therefore, management focuses on restoring sRV function—tricuspid valve replacement is not warranted. Interestingly, at least moderate post-operative TR after the atrial switch significantly predicted shorter overall survival and transplant-free survival, pointing to TR as a potential cause rather than a consequence of sRV dysfunction ( 54 ).…”

“…In agreement with these findings, Egbe et al attributed a significant survival benefit to early SAVV replacement in cc-TGA performed before the onset of sRV dysfunction, whereas CRT and medical therapy yielded no statistically significant benefits ( 84 ). Likewise, immediate post-operative SAVV regurgitation after the atrial switch operation negatively affects the survival of d-TGA patients ( 54 ). The ESC 2020 guidelines revised their 2010 recommendations for the management of adult CHDs, upgrading the indication for SAVV replacement in cc-TGA patients with SAVV regurgitation and mildly impaired sRV function (EF ≥ 40%) from class IIa to I ( 102 ), underscoring the importance of early intervention.…”

Atrial switch operation for transposition of the great arteries: tricuspid regurgitation matters

“…Hence, long-term management of patients after atrial switch for TGA remains challenging. According to the data presented,7 tricuspid regurgitation might well be one of the causes and not only a consequence of SRV dilatation and failure (figure 1). An earlier and perhaps more aggressive approach in addressing tricuspid valve regurgitation in TGA may be considered.…”

“…In the study recently published in Heart, Antonova and coauthors7 evaluated the impact of different preoperative and perioperative factors on long-term outcome in 454 patients after atrial switch repair in the Czech and Slovak Republics. All patients were operated at the same centre.…”