Cardiac Outcomes in Young Adult Survivors of the Arterial Switch Operation for Transposition of the Great Arteries

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:56

Article

Tobler, Daniel¹  Williams, William G.^2,3  Jegatheeswaran, Anusha^2,3  Van Arsdell, Glen S.^2,3  McCrindle, Brian W.^2,3  Greutmann, Matthias¹  Oechslin, Erwin N.¹  Silversides, Candice K.¹ 

[1] Univ Toronto, Div Cardiol, Toronto Congenital Cardiac Ctr Adults, Univ Hlth Network,Peter Munk Cardiac Ctr, Toronto, ON, Canada

[2] Hosp Sick Children, Dept Pediat, Div Cardiol & Cardiovasc Surg, Toronto, ON M5G 1X8, Canada

[3] Hosp Sick Children, Dept Surg, Div Cardiol & Cardiovasc Surg, Toronto, ON M5G 1X8, Canada

关键词: adult congenital heart disease;    outcome;    transposition of the great arteries;   

DOI  :  10.1016/j.jacc.2010.03.031

来源: Elsevier

【 摘 要 】

Objectives We sought to determine cardiac outcomes in young adults with complete transposition of the great arteries (TGA) after the arterial switch operation (ASO). Background Although cardiac outcomes in the pediatric population with TGA after ASO have been well described, outcomes in the adult population have not to our knowledge been studied. Methods We determined late survival in all operative survivors with TGA after ASO performed before 1991 at our local pediatric referring hospital. In the subset of adults (n = 65) followed in our adult congenital cardiac clinic, we examined cardiac outcomes in adulthood. Results Survival of the 132 infants discharged from hospital after ASO was 97% (70% confidence interval [CI]: 95.0% to 98.1%) at 20 years. In the 65 patients (mean age 21 +/- 3 years, 62% male) followed at our institution, 17% (11 of 65) had at least 1 clinically significant cardiac lesion, including ventricular dysfunction, valvular dysfunction, or arrhythmias. Residual lesions were more common in those who had had cardiac reinterventions in childhood (odds ratio: 10.7, 95% CI: 2.1 to 55). In adulthood, 5 patients (8%) had arrhythmia requiring treatment and 7 patients (11%) required reinterventions (5 reoperations and 2 pacemaker implantations). Intervention for aortic valve regurgitation and aortic root dilation were not observed. Exercise capacity was reduced in most adults (82%) after ASO. Conclusions Although most adults after ASO are well, and few have residual defects, there are subgroups, particularly those who needed further cardiac intervention in childhood, who are at higher risk for ventricular and valve dysfunction and arrhythmias. (J Am Coll Cardiol 2010; 56: 58-64) (C) 2010 by the American College of Cardiology Foundation

【 授权许可】

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