Cardiovascular Outcomes After the Arterial Switch Operation for D-Transposition of the Great Arteries

Background-Data regarding long-term outcomes after the arterial switch operation for D-transposition of the great arteries are scarce. Methods and 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. (Circulation. 2013; 127: 331-339.)