title: Cardiovascular outcomes after the arterial switch operation for D-transposition of the great arteries.
abstract: BACKGROUND
  Data regarding long-term outcomes after the arterial switch operation for D-transposition of the great arteries are scarce.
  
  
  RESULTS
  A single-institution retrospective cohort study was conducted to assess cardiovascular outcomes after an arterial switch operation between 1983 and 1999. Patients without follow-up visits within 3 years were contacted and secondary sources of information obtained. 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% in 34.2%. At least moderate neoaortic and pulmonary regurgitation were present in 3.4% and 6.6%, respectively, and more than mild neoaortic and pulmonary stenosis in 3.2% and 10.3%.
  
  
  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.
authors.affiliation: Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA. paul.khairy@cardio.CHBoston.org
authors.forename: Paul
authors.initials: P
authors.lastname: Khairy
authors.forename: Mathieu
authors.initials: M
authors.lastname: Clair
authors.forename: Susan M
authors.initials: SM
authors.lastname: Fernandes
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Blume
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Powell
authors.forename: Jane W
authors.initials: JW
authors.lastname: Newburger
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Landzberg
authors.forename: John E
authors.initials: JE
authors.lastname: Mayer
mesh_terms: D001145:Arrhythmias, Cardiac / Q000453:epidemiology; D013504:Cardiovascular Surgical Procedures / Q000379:methods*; D002319:Cardiovascular System / Q000503:physiopathology*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D014188:Transposition of Great Vessels / Q000401:mortality* / Q000601:surgery*