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. 2023 Dec 27;3(2):100772.
doi: 10.1016/j.jacadv.2023.100772. eCollection 2024 Feb.

Clinical Course of TGA After Arterial Switch Operation in the Current Era

Leo J Engele  1   2 , Roel L F van der Palen  3 , Renée S Joosen  4 , Gertjan T Sieswerda  5 , Paul H Schoof  6 , Joost P van Melle  7 , Rolf M F Berger  8 , Ryan E Accord  9 , Lukas A J Rammeloo  10 , Thelma C Konings  11 , Wim A Helbing  12 , Jolien W Roos-Hesselink  13 , Pieter C van de Woestijne  14 , Stefan Frerich  15 , Arie P J van Dijk  16   17 , Irene M Kuipers  18 , Mark G H Hazekamp  19 , Barbara J M Mulder  1   2 , Johannes M P J Breur  4 , Nico Blom  3   18 , Monique R M Jongbloed  20   21 , Berto J Bouma  1   2
Affiliations

Clinical Course of TGA After Arterial Switch Operation in the Current Era

Leo J Engele et al. JACC Adv. .

Abstract

Background: The number of patients with an arterial switch operation (ASO) for transposition of the great arteries (TGA) is steadily growing; limited information is available regarding the clinical course in the current era.

Objectives: The purpose was to describe clinical outcome late after ASO in a national cohort, including survival, rates of (re-)interventions, and clinical events.

Methods: A total of 1,061 TGA-ASO patients (median age 10.7 years [IQR: 2.0-18.2 years]) from a nationwide prospective registry with a median follow-up of 8.0 years (IQR: 5.4-8.8 years) were included. Using an analysis with age as the primary time scale, cumulative incidence of survival, (re)interventions, and clinical events were determined.

Results: At the age of 35 years, late survival was 93% (95% CI: 88%-98%). The cumulative re-intervention rate at the right ventricular outflow tract and pulmonary branches was 36% (95% CI: 31%-41%). Other cumulative re-intervention rates at 35 years were on the left ventricular outflow tract (neo-aortic root and valve) 16% (95% CI: 10%-22%), aortic arch 9% (95% CI: 5%-13%), and coronary arteries 3% (95% CI: 1%-6%). Furthermore, 11% (95% CI: 6%-16%) of the patients required electrophysiological interventions. Clinical events, including heart failure, endocarditis, and myocardial infarction occurred in 8% (95% CI: 5%-11%). Independent risk factors for any (re-)intervention were TGA morphological subtype (Taussig-Bing double outlet right ventricle [HR: 4.9, 95% CI: 2.9-8.1]) and previous pulmonary artery banding (HR: 1.6, 95% CI: 1.0-2.2).

Conclusions: TGA-ASO patients have an excellent survival. However, their clinical course is characterized by an ongoing need for (re-)interventions, especially on the right ventricular outflow tract and the left ventricular outflow tract indicating a strict lifelong surveillance, also in adulthood.

Keywords: arterial switch operation; long-term outcome; re-intervention; transposition of the great arteries.

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Conflict of interest statement

Support was received from the Netherlands Cardiovascular Research lnitiative: An initiative with support of the Dutch Heart Foundation and Hartekind, CVON2019-002 OUTREACH. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Cumulative Incidence of (Re-)Intervention, Clinical Event, and Death in TGA-ASO Cumulative incidence of first (re-)intervention during follow-up; all (re-)intervention (red), clinical event (blue) and death (green) in TGA-IVS (A), TGA-VSD (B), TB-DORV (C), all TGA subtypes (D). Cumulative incidence rates with age as a time scale were estimated for first occurrence of each outcome using a delayed entry method (R package survival) for left truncated data. (D) shows the cumulative incidence, calculated with spline interpolation, until the age of 40 years. ASO = arterial switch operation; IVS = intact ventricular septum; TB-DORV = Taussig Bing double outlet right ventricle; TGA = transposition of the great arteries; VSD = ventricular septum defect.
Figure 2
Figure 2
Sankey Diagram of Patients With One or Multiple (Re-)Interventions After ASO Sankey diagram: demonstrating the number of patients with single or multiple (re-)interventions after the arterial switch operation, categorized by the type of (re-)intervention. Electrophysiological (re-)interventions includes ablation, ICD and pacemaker placement. ASO = arterial switch operation; LVOT = left ventricular outflow tract; RVOT = right ventricular outflow tract.
Figure 3
Figure 3
Cumulative Incidence of (Re-)Intervention in TGA-ASO Cumulative incidence of first re-intervention during follow-up; all (re-)intervention (red), RVOT re-intervention (blue), LVOT re-intervention (green), and coronary artery re-intervention (purple) in TGA patients after ASO. Cumulative incidence rates with age as a time scale were estimated for first occurrence of each outcome using a delayed entry method (R package survival) for left truncated data. ASO = arterial switch operation; LVOT = left ventricular outflow tract; RVOT = right ventricular outflow tract; TGA = transposition of the great arteries.
Figure 4
Figure 4
Cumulative Incidence of First and Subsequently RVOT Re-Intervention in TGA-ASO Cumulative incidence of first (red) and subsequently (blue and green) RVOT re-intervention within the follow-up period in TGA patients after ASO. Cumulative incidence rates with age as a time scale were estimated for each outcome using a delayed entry method (R package survival) for left truncated data. ASO = arterial switch operation; RVOT = right ventricular outflow tract; TGA = transposition of the great arteries.
Central Illustration
Central Illustration
Clinical Course of TGA After ASO: Mortality and Re-Intervention Rates at 35 Years The figure demonstrates the clinical course of TGA after ASO at the age of 35 year. The mortality and re-intervention rates represents the calculated cumulative incidence at the age of 35 years for RVOT re-intervention, LVOT re-intervention, coronary artery re-intervention and death. The dotted line (and question mark) reflects the period after 35 years, in which the outcome is still unknown. ASO = arterial switch operation; LVOT = left ventricular outflow tract; RVOT = right ventricular outflow tract.
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References

    1. Brickner M.E., Hillis L.D., Lange R.A. Congenital heart disease in adults. First of two parts. N Engl J Med. 2000;342(4):256–263. - PubMed
    1. Jatene A.D., Fontes V.F., Paulista P.P., et al. Successful anatomic correction of transposition of the great vessels. A preliminary report. Arq Bras Cardiol. 1975;28(4):461–464. - PubMed
    1. van der Bom T., van der Palen R.L., Bouma B.J., et al. Persistent neo-aortic growth during adulthood in patients after an arterial switch operation. Heart. 2014;100(17):1360–1365. - PubMed
    1. Legendre A., Losay J., Touchot-Kone A., et al. Coronary events after arterial switch operation for transposition of the great arteries. Circulation. 2003;108 Suppl 1:II186–I190. - PubMed
    1. Co-Vu J.G., Ginde S., Bartz P.J., Frommelt P.C., Tweddell J.S., Earing M.G. Long-term outcomes of the neoaorta after arterial switch operation for transposition of the great arteries. Ann Thorac Surg. 2013;95(5):1654–1659. - PubMed

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