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Published on: July 18, 2014
Long-Term Outcomes After Atrial Switch Operation for Transposition of the Great Arteries
Craig S Broberg1, Alexandra van Dissel2, Jessica Minnier3
1Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA.
Insights
Adults with d-loop transposition of the great arteries (d-TGA) after atrial switch surgery face slow progression to heart failure. Key predictors for adverse outcomes include ventricular arrhythmia and heart failure admissions, aiding risk stratification.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Adult Congenital Heart Disease
Background:
- Adults with d-loop transposition of the great arteries (d-TGA) and a systemic right ventricle post-atrial switch require risk assessment for end-stage heart failure.
- Identifying factors predicting adverse outcomes is crucial for managing this complex patient population.
Purpose of the Study:
- To determine factors associated with survival in a large cohort of adults with d-TGA and prior atrial switch surgery.
- To identify predictors of end-stage heart failure outcomes in this population.
Main Methods:
- A multicenter, retrospective cohort study of adults with d-TGA and prior atrial switch surgery.
- Clinical data were collected from initial and most recent visits.
- The composite primary outcome included death, transplantation, or mechanical circulatory support (MCS).
Main Results:
- Over a median of 9.2 years, 91 out of 1,168 patients (8.8% per 10 person-years) experienced the primary outcome.
- Sudden/arrhythmic death occurred at a younger age compared to other causes of death.
- Independent 5-year predictors of adverse outcomes included prior ventricular arrhythmia, heart failure admission, complex anatomy, QRS duration >120 ms, and severe right ventricle dysfunction.
Conclusions:
- The progression to end-stage heart failure or death is generally slow for most adults with d-TGA after atrial switch.
- A simplified prediction score has been developed to identify individuals at the highest risk for adverse outcomes within a 5-year period.
Background:
For patients with d-loop transposition of the great arteries (d-TGA) with a systemic right ventricle after an atrial switch operation, there is a need to identify risks for end-stage heart failure outcomes.
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.
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