Outcome of Arterial Switch Operation for d-TGA

Circulation. 2013; 127: 331-339

Cardiovascular Outcomes After the Arterial Switch Operation for D-Transposition of the Great Arteries

Paul Khairy, MD, PhD et al. Boston.

Single-institution retrospective cohort study (1983-1999). n=400.

Overall, 400 patients, 154 (38.3%) with a ventricular septal defect, 238 (59.5%) with an intact septum, and 9 (2.3%) with a Taussig-Bing anomaly, were followed for a median of 18.7 years. In perioperative survivors, overall and arrhythmia-free survival rates at 25 years were 96.7±1.8% and 96.6±0.1%, respectively.

Late mortality was predominantly a result of sudden deaths and myocardial infarction.

At 25 years, 75.5±2.5% remained free from surgical or catheter-based reintervention.

Freedom from an adverse cardiovascular event was 92.9±1.9% at 25 years. Independent predictors were a single right coronary artery (hazard ratio, 4.58; 95% confidence interval, 1.32-15.90), P=0.0166) and postoperative heart failure (hazard ratio, 6.93; 95% confidence interval, 1.57-30.62; P=0.0107).

At last follow-up, the left ventricular ejection fraction was 60.3±8.9%, 97.3% had class I symptoms, and 5.2% obstructive coronary artery disease. Peak oxygen uptake was 35.1±7.6 mL/kg/min (86.1±15.1% predicted), with a chronotropic index <80 10.3="" 3.2="" 3.4="" 34.2="" 6.6="" and="" at="" in="" least="" mild="" moderate="" more="" neoaortic="" present="" pulmonary="" regurgitation="" respectively="" stenosis="" than="" were="">
Conclusions—Long-term and arrhythmia-free survival is excellent after arterial switch operation. Although sequelae include chronotropic incompetence and neoaortic, pulmonary, and coronary artery complications, most patients maintain normal systolic function and exercise capacity.