Cited 3 times since 2018 (2.2 per year) source: Scopus Heart (British Cardiac Society), Volume 105, Issue 10, 10 November 2018, Pages 790-796 Long-term outcome after atrial correction for transposition of the great arteries. Couperus LE, Vliegen HW, Zandstra TE, Kiès P, Jongbloed MRM, Holman ER, Zeppenfeld K, Hazekamp MG, Schalij MJ, Scherptong RWC

Objective

This study assessed adult survival and morbidity patterns in patients who underwent atrial correction according to Mustard or Senning for transposition of the great arteries (TGA).

Methods

In 76 adult patients with TGA (59% male) after atrial correction, long-term survival and morbidity were investigated in three periods

early (<15 years postoperatively), midterm (15-30 years postoperatively) and late (>30 years postoperatively).

Results

The Mustard technique was performed in 41 (54%) patients, and the Senning technique was performed in 35 (46%) patients aged 3.1 (

Iqr

2.1-3.8) and 1.0 (

Iqr

0.6-3.1; p<0.01) years, respectively. Adult survival was 82% at 39.7 (

Iqr

35.9-42.4) years postoperatively and exceeded 50 years in four patients. Supraventricular tachycardia (SVT) occurred in 51% of patients. The incidences of ventricular arrhythmia (0%, 8% and 13%; p<0.01), heart failure (0%, 5% and 19%; p<0.01) and surgical reinterventions (0%, 5% and 11%; p=0.01) increased from early to late follow-up. At last follow-up, RV function was depressed in 31 (46%) patients, and New York Heart Association functional class was ≥2 in 34 (48%) patients. Bradyarrhythmia, SVT and ventricular arrhythmia were associated with depressed RV function (

Or

4.47, 95% CI 1.50 to 13.28, p<0.01;

Or

3.74, 95% CI 1.26 to 11.14, p=0.02;

Or

14.40, 95% CI 2.80 to 74.07, p<0.01, respectively) and worse functional capacity (

Or

2.10, 95% CI 0.75 to 5.82, p=0.16;

Or

2.87, 95% CI 1.06 to 7.81, p=0.04;

Or

8.47, 95% CI 1.70 to 42.10, p<0.01, respectively).

Conclusions

In adult patients with TGA, survival was 82% at 39.7 (

Iqr

35.9-42.4) years after atrial correction. Morbidity was high and included SVT as most frequent adverse event. Ventricular arrhythmias, heart failure and surgical reinterventions were common during late follow-up. Adverse events were associated with depressed right ventricle function and reduced functional class.

Keywords: Transposition Of The Great Arteries, Complex Congenital Heart Disease

Heart. 2018 Nov;105(10):790-796