Abstract 16202: Outcome in Adult Patients after Arterial Switch Operation for Transposition of the Great Arteries
Background The early results of arterial switch operation (ASO) are encouraging but data on long-term outcome into adulthood are limited. We aimed to assess late outcome in adults with transposition of the great arteries after ASO.
Methods and Results We studied 145 adult patients (age>16, median 25yrs.) with ASO followed at our institution. Three patients died in adulthood (mortality 2.4/1,000-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 (>45mm in 3 patients, maximal-diameter 49mm) 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.
Conclusion 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. Conservative non-invasive monitoring for coronary complications appears to be safe in adult ASO patients.
- © 2012 by American Heart Association, Inc.