TY - JOUR
T1 - Clinical Course of TGA After Arterial Switch Operation in the Current Era
AU - Engele, Leo J.
AU - van der Palen, Roel L. F.
AU - Joosen, Renée S.
AU - Sieswerda, Gertjan T.
AU - Schoof, Paul H.
AU - van Melle, Joost P.
AU - Berger, Rolf M. F.
AU - Accord, Ryan E.
AU - Rammeloo, Lukas A. J.
AU - Konings, Thelma C.
AU - Helbing, Wim A.
AU - Roos-Hesselink, Jolien W.
AU - van de Woestijne, Pieter C.
AU - Frerich, Stefan
AU - van Dijk, Arie P. J.
AU - Kuipers, Irene M.
AU - Hazekamp, Mark G. H.
AU - Mulder, Barbara J. M.
AU - Breur, Johannes M. P. J.
AU - Blom, Nico
AU - Jongbloed, Monique R. M.
AU - Bouma, Berto J.
N1 - Publisher Copyright: © 2023 The Authors
PY - 2024/2/1
Y1 - 2024/2/1
N2 - 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.
AB - 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.
KW - arterial switch operation
KW - long-term outcome
KW - re-intervention
KW - transposition of the great arteries
UR - http://www.scopus.com/inward/record.url?scp=85182180945&partnerID=8YFLogxK
U2 - 10.1016/j.jacadv.2023.100772
DO - 10.1016/j.jacadv.2023.100772
M3 - Article
SN - 2772-963X
VL - 3
JO - JACC: Advances
JF - JACC: Advances
IS - 2
M1 - 100772
ER -