Multicenter Study

. 2022 Sep 6;80(10):951-963.

doi: 10.1016/j.jacc.2022.06.020.

Long-Term Outcomes After Atrial Switch Operation for Transposition of the Great Arteries

Craig S Broberg¹, Alexandra van Dissel², Jessica Minnier³, Jamil Aboulhosn⁴, Robert M Kauling⁵, Salil Ginde⁶, Eric V Krieger⁷, Fred Rodriguez 3rd⁸, Tripti Gupta⁹, Sangeeta Shah⁹, Anitha S John¹⁰, Timothy Cotts¹¹, W Aaron Kay¹², Marissa Kuo⁹, Cindy Dwight¹², Patricia Woods¹³, Jeremy Nicolarsen¹⁴, Berardo Sarubbi¹⁵, Flavia Fusco¹⁵, Petra Antonova¹⁶, Susan Fernandes¹⁷, Jasmine Grewal¹⁸, Jonathan Cramer¹⁹, Paul Khairy²⁰, Pastora Gallego²¹, Clare O'Donnell²², Jane Hannah²², Mikael Dellborg²³, Carla P Rodriguez-Monserrate²⁴, Isabelle Vonder Muhll²⁵, Stephen Pylypchuk²⁵, Anthony Magalski²⁶, Frank Han²⁷, Adam M Lubert²⁸, Joseph Kay²⁹, Elizabeth Yeung²⁹, Jolien Roos-Hesselink⁵, David Baker³⁰, David S Celermajer³⁰, Luke J Burchill³¹, William M Wilson³¹, Joshua Wong³¹, Shelby Kutty³², Alexander R Opotowsky³³

Affiliations

¹ Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA. Electronic address: brobergc@ohsu.edu.
² Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA; Amsterdam University Medical Center, Amsterdam, the Netherlands.
³ School of Public Health, Oregon Health and Science University, Portland, Oregon, USA.
⁴ UCLA Medical Center, Los Angeles, California, USA.
⁵ Erasmus Medical Center, Rotterdam, the Netherlands.
⁶ Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA.
⁷ University of Washington Medical Center and Seattle Children's Hospital, Seattle, Washington, USA.
⁸ Emory University Hospital, Atlanta, Georgia, USA.
⁹ Ochsner Medical Center, New Orleans, Louisiana, USA.
¹⁰ Children's National Hospital, Washington, DC, USA.
¹¹ University of Michigan Medical Center, Ann Arbor, Michigan, USA.
¹² Krannert Institute of Cardiology, Indianapolis, Indiana, USA.
¹³ Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA.
¹⁴ Providence Spokane, Spokane, Washington, USA.
¹⁵ Monaldi Hospital, Napoli, Italy.
¹⁶ University Hospital Motol, Prague, Czech Republic.
¹⁷ Stanford University, School of Medicine, Departments of Pediatrics and Medicine, Palo Alto, California, USA.
¹⁸ St. Paul's Hospital, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
¹⁹ Children's Hospital, Omaha & University of Nebraska Medical Center, Omaha, Nebraska, USA.
²⁰ Montreal Heart Institute, Montreal, Quebec, Canada.
²¹ Hospital Universitario Virgen Del Rocio, Sevilla, Spain.
²² Green Lane Paediatric and Congenital Cardiac Service, Auckland City Hospital, Auckland, New Zealand.
²³ Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
²⁴ Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA; Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
²⁵ University of Alberta, Edmonton, Alberta, Canada.
²⁶ Saint Luke's Hospital, Kansas City, Missouri, USA.
²⁷ University of Mississippi Medical Center, Jackson, Mississippi, USA.
²⁸ Cincinnati Children's Hospital Medical Center, Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
²⁹ Colorado University School of Medicine, Denver, Colorado, USA.
³⁰ University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
³¹ Royal Melbourne Hospital, Department of Medicine, Melbourne, Victoria, Australia.
³² Johns Hopkins University, Baltimore, Maryland, USA.
³³ Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA; Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Cincinnati Children's Hospital Medical Center, Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.

PMID: 36049802
DOI: 10.1016/j.jacc.2022.06.020

Free article

Multicenter Study

Long-Term Outcomes After Atrial Switch Operation for Transposition of the Great Arteries

Craig S Broberg et al. J Am Coll Cardiol. 2022.

Free article

. 2022 Sep 6;80(10):951-963.

doi: 10.1016/j.jacc.2022.06.020.

Authors

Affiliations

¹ Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA. Electronic address: brobergc@ohsu.edu.
² Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA; Amsterdam University Medical Center, Amsterdam, the Netherlands.
³ School of Public Health, Oregon Health and Science University, Portland, Oregon, USA.
⁴ UCLA Medical Center, Los Angeles, California, USA.
⁵ Erasmus Medical Center, Rotterdam, the Netherlands.
⁶ Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USA.
⁷ University of Washington Medical Center and Seattle Children's Hospital, Seattle, Washington, USA.
⁸ Emory University Hospital, Atlanta, Georgia, USA.
⁹ Ochsner Medical Center, New Orleans, Louisiana, USA.
¹⁰ Children's National Hospital, Washington, DC, USA.
¹¹ University of Michigan Medical Center, Ann Arbor, Michigan, USA.
¹² Krannert Institute of Cardiology, Indianapolis, Indiana, USA.
¹³ Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA.
¹⁴ Providence Spokane, Spokane, Washington, USA.
¹⁵ Monaldi Hospital, Napoli, Italy.
¹⁶ University Hospital Motol, Prague, Czech Republic.
¹⁷ Stanford University, School of Medicine, Departments of Pediatrics and Medicine, Palo Alto, California, USA.
¹⁸ St. Paul's Hospital, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
¹⁹ Children's Hospital, Omaha & University of Nebraska Medical Center, Omaha, Nebraska, USA.
²⁰ Montreal Heart Institute, Montreal, Quebec, Canada.
²¹ Hospital Universitario Virgen Del Rocio, Sevilla, Spain.
²² Green Lane Paediatric and Congenital Cardiac Service, Auckland City Hospital, Auckland, New Zealand.
²³ Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
²⁴ Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA; Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
²⁵ University of Alberta, Edmonton, Alberta, Canada.
²⁶ Saint Luke's Hospital, Kansas City, Missouri, USA.
²⁷ University of Mississippi Medical Center, Jackson, Mississippi, USA.
²⁸ Cincinnati Children's Hospital Medical Center, Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
²⁹ Colorado University School of Medicine, Denver, Colorado, USA.
³⁰ University of Sydney and Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
³¹ Royal Melbourne Hospital, Department of Medicine, Melbourne, Victoria, Australia.
³² Johns Hopkins University, Baltimore, Maryland, USA.
³³ Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA; Department of Medicine, Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Cincinnati Children's Hospital Medical Center, Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.

PMID: 36049802
DOI: 10.1016/j.jacc.2022.06.020

Abstract

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.

Keywords: QRS duration; atrial arrhythmia; congenital heart disease; congestive heart failure; systemic right ventricle; transposition of the great arteries.

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Conflict of interest statement

Funding Support and Author Disclosures 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.

Comment in

Late Systemic Right Ventricle Failure: Moving Toward a Real-Time Prediction Tool.
Karamlou T, Devlin PJ, Hammoud MS. Karamlou T, et al. J Am Coll Cardiol. 2022 Sep 6;80(10):964-966. doi: 10.1016/j.jacc.2022.06.021. J Am Coll Cardiol. 2022. PMID: 36049803 No abstract available.

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Long-Term Outcomes After Atrial Switch Operation for Transposition of the Great Arteries

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Long-Term Outcomes After Atrial Switch Operation for Transposition of the Great Arteries

Authors

Affiliations

Abstract

Conflict of interest statement

Comment in

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Grants and funding

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