Long-term outcome and quality of life after arterial switch operation: a prospective study with a historical comparison.
AIM.: The study aims to describe the long-term cardiological and psychological results of our first surgical cohort of arterial switch operation (ASO) patients and compare the results with our earlier series of Mustard patients. METHODS.: Twenty-four survivors of ASO operated in our center (1985-1990) were evaluated by electrocardiography, echocardiography, magnetic resonance imaging, exercise testing, 24-hour Holter-monitoring, and health-related quality of life questionnaire. The results were compared with 58 adult Mustard patients who were evaluated in 2001 using the same study protocol. RESULTS.: Arterial switch operation was performed at a median age of 13 days and Mustard operation at 2 years. Median follow-up was 22 years (range 20-25) and 25 years (22-29), respectively. After ASO, survival was better (P =.04). The event-free survival after 22 years was 77% after ASO vs. 44% after Mustard (P =.03). Good systemic ventricular function was present in 93% after ASO vs. 6% after Mustard (P <.01). Exercise capacity in ASO was 85% of predicted, compared with 72% in Mustard patients (P =.01). Aortic regurgitation was found in 21% of ASO patients vs. 16% in Mustard patients. Arterial switch patients vs. Mustard patients reported significantly better quality of life and less somatic complaints. CONCLUSION.: The progression made in surgical treatment for transposition of the great arteries from Mustard to ASO has had a positive impact on survival, cardiac function, exercise capacity, and also self-reported quality of life and somatic complaints. Longer follow-up is warranted to monitor aortic regurgitation.
Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands. p.ruys@erasmusmc.nl
Titia P E
TP
Ruys
Annemien E
AE
van der Bosch
Judith A A E
JA
Cuypers
Maarten
M
Witsenburg
Willem A
WA
Helbing
Ad J J C
AJ
Bogers
Ron
R
van Domburg
Jacky S
JS
McGhie
Marcel L
ML
Geleijnse
Jens
J
Henrichs
Elisabeth
E
Utens
Heleen B
HB
Van der Zwaan
Johanna J M
JJ
Takkenberg
Jolien W
JW
Roos-Hesselink
D000328:Adult; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000523:psychology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000523:psychology; D002675:Child, Preschool; D018572:Disease-Free Survival; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D009426:Netherlands; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000401:mortality / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D016896:Treatment Outcome; D016276:Ventricular Function; D055815:Young Adult