Year: 2023
Type: article
Study design: Observational Study
Abstract: Background: The number of patients with an arterial switch operation (ASO) for transposition of the great arteries (TGA) is steadily growing; limited information is available regarding the clinical course in the current era. Objectives: The purpose was to describe clinical outcome late after ASO in a national cohort, including survival, rates of (re-)interventions, and clinical events. Methods: A total of 1,061 TGA-ASO patients (median age 10.7 years [IQR: 2.0-18.2 years]) from a nationwide prospective registry with a median follow-up of 8.0 years (IQR: 5.4-8.8 years) were included. Using an analysis with age as the primary time scale, cumulative incidence of survival, (re)interventions, and clinical events were determined. Results: At the age of 35 years, late survival was 93% (95% CI: 88%-98%). The cumulative re-intervention rate at the right ventricular outflow tract and pulmonary branches was 36% (95% CI: 31%-41%). Other cumulative re-intervention rates at 35 years were on the left ventricular outflow tract (neo-aortic root and valve) 16% (95% CI: 10%-22%), aortic arch 9% (95% CI: 5%-13%), and coronary arteries 3% (95% CI: 1%-6%). Furthermore, 11% (95% CI: 6%-16%) of the patients required electrophysiological interventions. Clinical events, including heart failure, endocarditis, and myocardial infarction occurred in 8% (95% CI: 5%-11%). Independent risk factors for any (re-)intervention were TGA morphological subtype (Taussig-Bing double outlet right ventricle [HR: 4.9, 95% CI: 2.9-8.1]) and previous pulmonary artery banding (HR: 1.6, 95% CI: 1.0-2.2). Conclusions: TGA-ASO patients have an excellent survival. However, their clinical course is characterized by an ongoing need for (re-)interventions, especially on the right ventricular outflow tract and the left ventricular outflow tract indicating a strict lifelong surveillance, also in adulthood.
Source: JACC Advances
Authors: Leo J. Engele, Roel L.F. van der Palen, Renée S. Joosen, Gertjan T. Sieswerda, Paul H. Schoof, Joost P. van Melle, Rolf M.F. Berger, Ryan E. Accord, Lukas A.J. Rammeloo, Thelma C. Konings, Wim A. Helbing, Jolien W. Roos-Hesselink, Pieter C. van de Woestijne, Stefan Frerich, Arie P.J. van Dijk, Irene M. Kuipers, Mark G.H. Hazekamp, Barbara J.M. Mulder, Johannes M.P.J. Breur, Nico Blom, Monique R.M. Jongbloed, Berto J. Bouma
Institutions: Netherlands Heart Institute, Amsterdam University Medical Centers, University of Amsterdam, Leiden University Medical Center, University Medical Center Utrecht, Wilhelmina Children's Hospital, University Medical Center Groningen, University of Groningen, Beatrix Kinderziekenhuis, Vrije Universiteit Amsterdam, Erasmus MC, Maastricht University Medical Centre, Radboud University Medical Center
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,550
OpenAlex ID: W4390289529