title: Outcome in adult patients after arterial switch operation for transposition of the great arteries.
abstract: BACKGROUND
  The arterial switch operation (ASO) is currently the treatment of choice in neonates with transposition of the great arteries (TGA). The outcome in childhood is encouraging but only limited data for long-term outcome into adulthood exist.
  
  
  RESULTS
  We studied 145 adult patients (age>16, median 25 years) with ASO followed at our institution. Three patients died in adulthood (mortality 2.4/1000-patient-years). Most patients were asymptomatic and had normal left ventricular function. Coronary lesions requiring interventions were rare (3 patients) and in most patients related to previous surgery. There were no acute coronary syndromes. Aortic root dilatation was frequent (56% patients) but rarely significant (>45 mm in 3 patients, maximal-diameter 49 mm) and appeared not to be progressive. There were no acute aortic events and no patient required elective aortic root surgery. Progressive neo-aortic-valve dysfunction was not observed in our cohort and only 1 patient required neo-aortic-valve replacement. Many patients (42.1%), however, had significant residual lesions or required reintervention in adulthood. Right ventricular outflow tract lesions or dysfunction of the neo-pulmonary-valve were frequent and 8 patients (6%) required neo-pulmonary-valve replacement. Cardiac interventions during childhood (OR 3.0, 95% CI 1.7-5.4, P<0.0001) were strong predictors of outcome (cardiac intervention/significant residual lesion/death) in adulthood.
  
  
  CONCLUSIONS
  Adult patients with previous ASO remain free of acute coronary or aortic complications and have low mortality. However, a large proportion of patients require re-interventions or present with significant right sided lesions. Life-long cardiac follow-up is, therefore, warranted. Periodic noninvasive surveillance for coronary complications appears to be safe in adult ASO patients.
authors.affiliation: Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, London, UK. a.kempny@rbht.nhs.uk
authors.forename: Aleksander
authors.initials: A
authors.lastname: Kempny
authors.forename: Kerstin
authors.initials: K
authors.lastname: Wustmann
authors.forename: Francesco
authors.initials: F
authors.lastname: Borgia
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Dimopoulos
authors.forename: Anselm
authors.initials: A
authors.lastname: Uebing
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.forename: Sylvia S
authors.initials: SS
authors.lastname: Chen
authors.forename: Adam
authors.initials: A
authors.lastname: Piorkowski
authors.forename: Rosemary
authors.initials: R
authors.lastname: Radley-Smith
authors.forename: Magdi H
authors.initials: MH
authors.lastname: Yacoub
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gatzoulis
authors.forename: Darryl F
authors.initials: DF
authors.lastname: Shore
authors.forename: Lorna
authors.initials: L
authors.lastname: Swan
authors.forename: Gerhard-Paul
authors.initials: GP
authors.lastname: Diller
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000639:trends*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology*; D016208:Databases, Factual / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D014188:Transposition of Great Vessels / Q000453:epidemiology* / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult