Long-Term Outcomes After Atrial Switch Operation for Transposition of the Great Arteries.
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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, Opotowsky Alexander R
Аннотация
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.