Abstract 1978: Cardiac Complications in Adults After Arterial Switch Operation for Transpostion of the Great Arteries
Background: The number of patients with arterial switch operation (ASO) for transposition of the great arteries (TGA) is growing. The objective of this study was to examine cardiac complications in an adult cohort of patients with ASO for TGA.
Methods: This was a review of outcomes in adult (age≥18 years) perioperative survivors of ASO for TGA followed in our clinic. All clinical, cardiac imaging and exercise studies were reviewed. The frequency of reinterventions and other adverse cardiac events (myocardial infarction, stroke and/or sustained arrhythmias) were determined.
Results: In total, 129 children survived an ASO surgery before 1991 at our local referring pediatric hospital and of these, 65 patients are followed at our adult clinic and were included in this study. The remaining cohort is followed elsewhere and had similar baseline patients characteristics to our cohort. The mean age at the last visit was 21±3 years (median age of repair 7 days; 62% male, 11% right ventricle to pulmonary artery (RV-PA) conduit). Forty-two percent (27/65) of the patients had reintervention in childhood; 1 heart transplantation and 26 reinterventions (35% vs 86% in patients with and without RV-PA conduits). Nine patients had more than one reintervention and in 4 of these patients, reinterventions were performed in adulthood (mean age 21±4 years). There were 2 patients who had undergone aortic valve replacement (age 12 and 17 years) and 1 who had undergone mitral valve replacement (age 20 years). Other adverse cardiac events occurred in 7 patients (11%, mean age 14±7 years), arrhythmias being the most common (2 older teenager, 3 adults). No patients had coronary events after childhood. At last follow up, 98% of the adults are in NYHA functional class I and their mean % predicted peak oxygen consumption is 73 ± 14%. Seventeen percent of the cohort (11/64) have left ventricular systolic dysfunction (ejection fraction <55%, mostly mild) and 15% (9/62) have echocardiographic evidence of > mild aortic regurgitation.
Conclusion: While most young adults with ASO for TGA are doing well, they remain at risk for cardiac complications. A subset have residual LV dysfunction and/or aortic regurgitation. Thus, continued surveillance is required in this cohort of patients.