Cardiac outcomes in young adult survivors of the arterial switch operation for transposition of the great arteries.
OBJECTIVE
We sought to determine cardiac outcomes in young adults with complete transposition of the great arteries (TGA) after the arterial switch operation (ASO).


BACKGROUND
Although cardiac outcomes in the pediatric population with TGA after ASO have been well described, outcomes in the adult population have not to our knowledge been studied.


METHODS
We determined late survival in all operative survivors with TGA after ASO performed before 1991 at our local pediatric referring hospital. In the subset of adults (n = 65) followed in our adult congenital cardiac clinic, we examined cardiac outcomes in adulthood.


RESULTS
Survival of the 132 infants discharged from hospital after ASO was 97% (70% confidence interval [CI]: 95.0% to 98.1%) at 20 years. In the 65 patients (mean age 21 +/- 3 years, 62% male) followed at our institution, 17% (11 of 65) had at least 1 clinically significant cardiac lesion, including ventricular dysfunction, valvular dysfunction, or arrhythmias. Residual lesions were more common in those who had had cardiac reinterventions in childhood (odds ratio: 10.7, 95% CI: 2.1 to 55). In adulthood, 5 patients (8%) had arrhythmia requiring treatment and 7 patients (11%) required reinterventions (5 reoperations and 2 pacemaker implantations). Intervention for aortic valve regurgitation and aortic root dilation were not observed. Exercise capacity was reduced in most adults (82%) after ASO.


CONCLUSIONS
Although most adults after ASO are well, and few have residual defects, there are subgroups, particularly those who needed further cardiac intervention in childhood, who are at higher risk for ventricular and valve dysfunction and arrhythmias.
Tobler
Daniel
D
Division of Cardiology, University of Toronto, Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
Williams
William G
WG
Jegatheeswaran
Anusha
A
Van Arsdell
Glen S
GS
McCrindle
Brian W
BW
Greutmann
Matthias
M
Oechslin
Erwin N
EN
Silversides
Candice K
CK
D000293:Adolescent; D000328:Adult; D013504:Cardiovascular Surgical Procedures; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000209:etiology; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications; D012086:Reoperation; D014188:Transposition of Great Vessels / Q000601:surgery*; D016896:Treatment Outcome