Assessing the Utility of Routine Surveillance Echocardiograms After Arterial Switch Operation in Adults With...

Current guidelines recommend annual or biennial transthoracic echocardiograms for patients with d-transposition of the great arteries (d-TGA) who have undergone an arterial switch operation (ASO), but optimal imaging frequency is unknown. We sought to determine the utility of annual surveillance echocardiograms for asymptomatic patients.

Clinical documentation from 2011 to 2023 for asymptomatic patients ≥18 years old with a history of d-TGA and ASO at a single large tertiary care center was reviewed to determine whether routine surveillance echocardiograms resulted in changes in clinical management (ΔMGMT), categorized as procedures (surgery or catheterization) or noninvasive changes (medication changes, additional imaging, etc.). Echocardiograms obtained for symptoms or completed before age 18 were excluded from analysis. Data were evaluated with chi-square and Kruskal-Wallis tests, Kaplan-Meier analysis, and Cox proportional hazard analysis.

For 416 echocardiograms from 127 patients, the median time from ASO to final echocardiogram was 22.2 years (interquartile range, 19.1-25.7 years; range, 15.2-34.1 years). Eighteen echocardiograms (4.32%) resulted in ΔMGMT for 12 patients including 8 (1.92%) medication changes, 7 (1.68%) cardiac computed tomography or magnetic resonance imaging studies, and 1 (0.24%) each for cardiac catheterization and surgery. A significantly larger proportion of patients with ΔMGMT underwent ASO at age ≥1 year compared to patients without ΔMGMT (36.36% vs 6.14%; P < .01). Patients with a history of hypertension, arrhythmia, ≥2 sternotomies, or neoaortic valve replacement had a significantly greater risk of ΔMGMT, as did those with neoaortic root dilation >4.5 cm and/or moderate or greater neoaortic insufficiency.

Routine surveillance echocardiograms are low yield in asymptomatic adults up to 30 years after ASO for d-TGA, suggesting it may be reasonable to increase the time interval between routine echocardiograms without adversely impacting care. Higher-risk subpopulations including those with ASO at older ages, ≥2 sternotomies, neoaortic valve replacement, and/or neoaortic valve/root pathology may benefit from continued frequent surveillance.