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 - Funding Information: The authors gratefully acknowledge the work of Beth Wilson (Portland, Oregon, USA), Amanda Sammons (Cincinnati, Ohio, USA), Melissa Major (Palo Alto, California, USA), Mikyla Janzen (Vancouver, BC, Canada), Sandra Jaidzeka (Washington, DC, USA), and Mary Stumpf (Indianapolis, Indiana, USA), for their assistance in research coordination. In addition, the authors appreciate Dr Michael Earing, University of Chicago Medicine and Comer Children's Hospital, Chicago, Illinois, USA, for his contribution to the overall study design, execution, and interpretation. Funding Information: This study was funded by a joint grant from the Children’s Heart Foundation and the American Heart Association (17GRNT33670334). Dr Opotowsky was supported by the Heart Institute Research Core at Cincinnati Children’s Hospital and the Dunlevie Family Fund. The authors used the Research Electronic Data Capture (REDCap) online database, which is funded by the National Institutes of Health (UL1TR002369). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. 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
UR - http://www.scopus.com/inward/record.url?scp=85136309311&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jacc.2022.06.020
DO - https://doi.org/10.1016/j.jacc.2022.06.020
M3 - Article
C2 - 36049802
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 -