Outcome in adult patients after arterial switch operation for transposition of the great arteries

Kempny, Aleksander; Wustmann, Kerstin; Borgia, Francesco; Dimopoulos, Konstantinos; Uebing, Anselm; Li, Wei; Chen, Sylvia S; Piorkowski, Adam; Radley-Smith, Rosemary; Yacoub, Magdi H; Gatzoulis, Michael A; Shore, Darryl F; Swan, Lorna; Diller, Gerhard-Paul (2012). Outcome in adult patients after arterial switch operation for transposition of the great arteries. International journal of cardiology, 167(10), pp. 2588-2593. Amsterdam: Elsevier 10.1016/j.ijcard.2012.06.066

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BACKGROUND: The arterial switch operation (ASO) is currently the treatment of choice in neonates with transposition of the great arteries (TGA). The outcome in childhood is encouraging but only limited data for long-term outcome into adulthood exist. METHODS AND RESULTS: We studied 145 adult patients (age>16, median 25years) with ASO followed at our institution. Three patients died in adulthood (mortality 2.4/1000-patient-years). Most patients were asymptomatic and had normal left ventricular function. Coronary lesions requiring interventions were rare (3 patients) and in most patients related to previous surgery. There were no acute coronary syndromes. Aortic root dilatation was frequent (56% patients) but rarely significant (>45mm in 3 patients, maximal-diameter 49mm) and appeared not to be progressive. There were no acute aortic events and no patient required elective aortic root surgery. Progressive neo-aortic-valve dysfunction was not observed in our cohort and only 1 patient required neo-aortic-valve replacement. Many patients (42.1%), however, had significant residual lesions or required reintervention in adulthood. Right ventricular outflow tract lesions or dysfunction of the neo-pulmonary-valve were frequent and 8 patients (6%) required neo-pulmonary-valve replacement. Cardiac interventions during childhood (OR 3.0, 95% CI 1.7-5.4, P<0.0001) were strong predictors of outcome (cardiac intervention/significant residual lesion/death) in adulthood. CONCLUSIONS: Adult patients with previous ASO remain free of acute coronary or aortic complications and have low mortality. However, a large proportion of patients require re-interventions or present with significant right sided lesions. Life-long cardiac follow-up is, therefore, warranted. Periodic noninvasive surveillance for coronary complications appears to be safe in adult ASO patients.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Wustmann, Kerstin Brigitte

ISSN:

0167-5273

Publisher:

Elsevier

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:37

Last Modified:

26 Feb 2014 08:10

Publisher DOI:

10.1016/j.ijcard.2012.06.066

PubMed ID:

22884697

Web of Science ID:

000308012400044

URI:

https://boris.unibe.ch/id/eprint/15028 (FactScience: 222182)

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