Long-term outcomes amongst adults with anatomic repair for transposition of the great arteries: Not as perfect as we would have hoped?

Abstract

Most of the patients who underwent arterial switch operation (ASO) for D-transposition of the great arteries (D-TGA) reach adulthood. However, they may have residual lesions necessitating lifelong surveillance. We aimed to evaluate the long-term outcomes of a large number of contemporary ASO patients. We examined late major adverse cardiovascular events (MACE) in adult TGA patients (> 16 years) who underwent an ASO between 1980 and 2002 and continued their follow-up in 2 major tertiary ACHD centers. MACE were defined as death, re-intervention, myocardial ischemia, arrhythmia, stroke/transient ischemic attack, infective endocarditis and heart failure. Overall, 306 patients (67% male, mean age 25 ± 5years) were followed in adult life for a median of 8 years [IQR 6–13]. Seventy-three (23.8%) patients experience MACE, including 40 medical events and 60 reinterventions. MACE -free survival at 2, 5, and 10 years of follow-up in adulthood was 93.0%, 85.1%, 70.7%, respectively. Atrial arrhythmia was the most frequent cardiac event with an incidence of 3.8‰ patient-years, whereas the incidence of life-threatening ventricular tachyarrhythmia was 1.7‰. Coronary artery disease was diagnosed in 11 (3.5%) patients. The most frequent indication for cardiac intervention was right ventricular outflow tract obstruction ( n = 40/60, 66.7%) followed by coronary revascularisation procedure ( n = 11/60, 18.3%), Fig. 1 . On multivariate analysis, history of cardiac complications during infancy (HR 2.7, 95%CI:1.6–4.5, P < 0.01) and uncommon coronary patterns (HR for type B/C/D/E versus type A 1.7, 95%CI:1.0–2.9, P = 0.03) were independent predictors of MACE in adulthood. MACE are common in adult patients with ASO for TGA, particularly those with a history of cardiovascular complications during childhood and uncommon coronary pattern. Consequently, all patients with an anatomic repair for TGA merit life-long tertiary care.