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Published on: November 18, 2018
Long-term outcome after atrial correction for transposition of the great arteries
Lotte E Couperus1, Hubert W Vliegen1, Tjitske E Zandstra1
1Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
Insights
Adults surviving atrial correction for transposition of the great arteries (TGA) show 82% survival past 39 years. Morbidity, including supraventricular tachycardia (SVT) and heart failure, increases over time, linked to reduced right ventricle function.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Adult Congenital Heart Disease
Background:
- Transposition of the great arteries (TGA) is a complex congenital heart defect.
- Atrial correction procedures like the Mustard and Senning techniques aim to reroute blood flow.
- Long-term outcomes in adults who underwent these repairs are crucial for understanding lifelong management.
Purpose of the Study:
- To assess long-term survival and morbidity patterns in adult patients following atrial correction for TGA.
- To investigate the incidence of arrhythmias, heart failure, and need for reintervention over time.
- To identify associations between adverse events, right ventricle function, and functional capacity.
Main Methods:
- A retrospective study of 76 adult patients with TGA who underwent Mustard or Senning atrial correction.
- Patients were analyzed based on follow-up duration: early (<15 years), midterm (15-30 years), and late (>30 years).
- Data collected included survival rates, incidence of supraventricular tachycardia (SVT), ventricular arrhythmias, heart failure, reinterventions, right ventricle (RV) function, and New York Heart Association (NYHA) functional class.
Main Results:
- Adult survival was 82% at a mean follow-up of 39.7 years postoperatively.
- Supraventricular tachycardia (SVT) affected 51% of patients; incidences of ventricular arrhythmia, heart failure, and reinterventions increased significantly with time.
- Depressed RV function was observed in 46% of patients, and 48% had NYHA functional class ≥2. Arrhythmias and worse functional capacity were linked to depressed RV function.
Conclusions:
- Long-term survival after atrial correction for TGA is substantial, but morbidity remains high.
- Progressive increases in arrhythmias, heart failure, and reinterventions highlight the need for lifelong monitoring.
- Impaired RV function and reduced functional capacity are significant concerns in this adult TGA population.
Objective:
This study assessed adult survival and morbidity patterns in patients who underwent atrial correction according to Mustard or Senning for transposition of the great arteries (TGA).
Methods:
In 76 adult patients with TGA (59% male) after atrial correction, long-term survival and morbidity were investigated in three periods: early (<15 years postoperatively), midterm (15-30 years postoperatively) and late (>30 years postoperatively).
Results:
The Mustard technique was performed in 41 (54%) patients, and the Senning technique was performed in 35 (46%) patients aged 3.1 (IQR: 2.1-3.8) and 1.0 (IQR: 0.6-3.1; p<0.01) years, respectively. Adult survival was 82% at 39.7 (IQR: 35.9-42.4) years postoperatively and exceeded 50 years in four patients. Supraventricular tachycardia (SVT) occurred in 51% of patients. The incidences of ventricular arrhythmia (0%, 8% and 13%; p<0.01), heart failure (0%, 5% and 19%; p<0.01) and surgical reinterventions (0%, 5% and 11%; p=0.01) increased from early to late follow-up. At last follow-up, RV function was depressed in 31 (46%) patients, and New York Heart Association functional class was ≥2 in 34 (48%) patients. Bradyarrhythmia, SVT and ventricular arrhythmia were associated with depressed RV function (OR: 4.47, 95% CI 1.50 to 13.28, p<0.01; OR: 3.74, 95% CI 1.26 to 11.14, p=0.02; OR: 14.40, 95% CI 2.80 to 74.07, p<0.01, respectively) and worse functional capacity (OR: 2.10, 95% CI 0.75 to 5.82, p=0.16; OR: 2.87, 95% CI 1.06 to 7.81, p=0.04; OR: 8.47, 95% CI 1.70 to 42.10, p<0.01, respectively).
Conclusions:
In adult patients with TGA, survival was 82% at 39.7 (IQR: 35.9-42.4) years after atrial correction. Morbidity was high and included SVT as most frequent adverse event. Ventricular arrhythmias, heart failure and surgical reinterventions were common during late follow-up. Adverse events were associated with depressed right ventricle function and reduced functional class.
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