Cardiovascular Outcomes After the Arterial Switch Operation for D-Transposition of the Great Arteries

Study Questions:

What are the long-term outcomes after the arterial switch operation (ASO) for D-transposition of the great arteries (D-TGA)?

Methods:

A retrospective review of patients undergoing ASO for D-TGA between 1983 and 1999, was performed at a single center. Patients without follow-up visits within 3 years were contacted, and secondary sources of information were obtained.

Results:

Between 1983 and 1999, 400 patients underwent arterial switch procedures, of which 238 (59.5%) had an intact ventricular septum, 154 (38.3%) had a ventricular septal defect, and 9 (2.3%) had a Taussig-Bing anomaly. Perioperative death occurred in 26 (6.5%), and late death occurred in 6 (1.5%). The majority of perioperative deaths occurred in the early operative era. In perioperative survivors, the survival rate at 25 years was 96.7 ± 1.8%, whereas the arrhythmia-free survival rate was 96.6 ± 0.1%. The mean aortic root size was 30.8 ± 8.3 mm, with 6.5% of patients having an aortic root >40 mm and one patient with an aortic root >50 mm. The mean left ventricular ejection fraction was 60.3 ± 8.9%, 97.3% had class I symptoms, 5.2% had obstructive coronary artery disease, and peak VO2 was 35.1 ± 7.6 ml/kg/min.

Conclusions:

The authors concluded that long-term survival and functional status are excellent after the ASO.

Perspective:

Long-term outcomes after the ASO remain uncertain, with concerns for coronary insufficiency and other anatomic issues including aortic root dilatation. This study shows excellent long-term results after the ASO. Most coronary events in the study occurred very early postoperatively, in the first 3 months. Patients with sudden death were previously known to be sick, with one patient having suprasystemic pulmonary pressure and another with severe ventricular dysfunction, known ventricular tachycardia, and an implantable defibrillator. Additionally, aortic root dilatation did not seem to be problematic, with no dissections seen. While 6.5% of patients had an aortic root >40 mm, only one patient had an aortic root >50 mm. This study provides additional data that the ASO appears to be meeting the expectations of decreased arrhythmia risk and improved long-term functional status as compared with atrial switch procedures.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Valvular Heart Disease, Implantable Devices, SCD/Ventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and CHD & Pediatrics, Cardiac Surgery and VHD, Congenital Heart Disease, CHD & Pediatrics and Arrhythmias, CHD & Pediatrics and Quality Improvement

Keywords: Coronary Artery Disease, Follow-Up Studies, Heart Defects, Congenital, Survival Rate, Heart Valve Diseases, Dilatation, Heart Septal Defects, Ventricular, Transposition of Great Vessels, Death, Sudden, Cardiac, Defibrillators, Implantable


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