TY - JOUR
T1 - Long-Term Outcomes After Atrial Switch Operation for Transposition of the Great Arteries
AU - Broberg, Craig S.
AU - van Dissel, Alexandra
AU - Minnier, Jessica
AU - Aboulhosn, Jamil
AU - Kauling, Robert M.
AU - Ginde, Salil
AU - Krieger, Eric V.
AU - Rodriguez, Fred
AU - Gupta, Tripti
AU - Shah, Sangeeta
AU - John, Anitha S.
AU - Cotts, Timothy
AU - Kay, W. Aaron
AU - Kuo, Marissa
AU - Dwight, Cindy
AU - Woods, Patricia
AU - Nicolarsen, Jeremy
AU - Sarubbi, Berardo
AU - Fusco, Flavia
AU - Antonova, Petra
AU - Fernandes, Susan
AU - Grewal, Jasmine
AU - Cramer, Jonathan
AU - Khairy, Paul
AU - Gallego, Pastora
AU - O'Donnell, Clare
AU - Hannah, Jane
AU - Dellborg, Mikael
AU - Rodriguez-Monserrate, Carla P.
AU - Muhll, Isabelle Vonder
AU - Pylypchuk, Stephen
AU - Magalski, Anthony
AU - Han, Frank
AU - Lubert, Adam M.
AU - Kay, Joseph
AU - Yeung, Elizabeth
AU - Roos-Hesselink, Jolien
AU - Baker, David
AU - Celermajer, David S.
AU - Burchill, Luke J.
AU - Wilson, William M.
AU - Wong, Joshua
AU - Kutty, Shelby
AU - Opotowsky, Alexander R.
N1 - Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/9/6
Y1 - 2022/9/6
N2 - 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.
AB - 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.
KW - QRS duration
KW - atrial arrhythmia
KW - congenital heart disease
KW - congestive heart failure
KW - systemic right ventricle
KW - transposition of the great arteries
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U2 - 10.1016/j.jacc.2022.06.020
DO - 10.1016/j.jacc.2022.06.020
M3 - Article
C2 - 36049802
AN - SCOPUS:85136309311
SN - 0735-1097
VL - 80
SP - 951
EP - 963
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 10
ER -