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Congenital heart disease
Original research article
Long-term outcome after atrial correction for transposition of the great arteries
  1. Lotte E Couperus1,
  2. Hubert W Vliegen1,
  3. Tjitske E Zandstra1,
  4. Philippine Kiès1,
  5. Monique R M Jongbloed1,2,
  6. Eduard R Holman1,
  7. Katja Zeppenfeld1,
  8. Mark G Hazekamp3,
  9. Martin J Schalij1,
  10. Roderick W C Scherptong1
  1. 1 Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
  2. 2 Department of Anatomy, Leiden University Medical Center, Leiden, The Netherlands
  3. 3 Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, The Netherlands
  1. Correspondence to Dr Roderick W C Scherptong, Department of Cardiology, Leiden University Medical Centre, Leiden 2300, ZA, The Netherlands; r.w.c.scherptong{at}lumc.nl

Abstract

Objective This study assessed adult survival and morbidity patterns in patients who underwent atrial correction according to Mustard or Senning for transposition of the great arteries (TGA).

Methods In 76 adult patients with TGA (59% male) after atrial correction, long-term survival and morbidity were investigated in three periods: early (<15 years postoperatively), midterm (15–30 years postoperatively) and late (>30 years postoperatively).

Results The Mustard technique was performed in 41 (54%) patients, and the Senning technique was performed in 35 (46%) patients aged 3.1 (IQR: 2.1–3.8) and 1.0 (IQR: 0.6–3.1; p<0.01) years, respectively. Adult survival was 82% at 39.7 (IQR: 35.9–42.4) years postoperatively and exceeded 50 years in four patients. Supraventricular tachycardia (SVT) occurred in 51% of patients. The incidences of ventricular arrhythmia (0%, 8% and 13%; p<0.01), heart failure (0%, 5% and 19%; p<0.01) and surgical reinterventions (0%, 5% and 11%; p=0.01) increased from early to late follow-up. At last follow-up, RV function was depressed in 31 (46%) patients, and New York Heart Association functional class was ≥2 in 34 (48%) patients. Bradyarrhythmia, SVT and ventricular arrhythmia were associated with depressed RV function (OR: 4.47, 95% CI 1.50 to 13.28, p<0.01; OR: 3.74, 95% CI 1.26 to 11.14, p=0.02; OR: 14.40, 95% CI 2.80 to 74.07, p<0.01, respectively) and worse functional capacity (OR: 2.10, 95% CI 0.75 to 5.82, p=0.16; OR: 2.87, 95% CI 1.06 to 7.81, p=0.04; OR: 8.47, 95% CI 1.70 to 42.10, p<0.01, respectively).

Conclusions In adult patients with TGA, survival was 82% at 39.7 (IQR: 35.9–42.4) years after atrial correction. Morbidity was high and included SVT as most frequent adverse event. Ventricular arrhythmias, heart failure and surgical reinterventions were common during late follow-up. Adverse events were associated with depressed right ventricle function and reduced functional class.

  • transposition of the great arteries
  • complex congenital heart disease

https://doi.org/10.1136/heartjnl-2018-313647

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    Footnotes

    • Contributors All authors have contributed significantly to the submitted work and approved submission of the manuscript. LEC: conception and design of the research, acquisition of data, statistical analysis and interpretation of the data, drafting the manuscript, critical revision of the manuscript for important intellectual content and final approval of the manuscript. HWV, TEZ and MJS: conception and design of the research, analysis and interpretation of the data, critical revision of the manuscript for important intellectual content and final approval of the manuscript. PK, MRMJ, ERH, KZ and MGH: conception and design of the research, acquisition of data, analysis and interpretation of the data, drafting the manuscript, critical revision of the manuscript for important intellectual content and final approval of the manuscript. RWCS: conception and design of the research, acquisition of data, analysis and interpretation of the data, supervising the work, drafting the manuscript, critical revision of the manuscript for important intellectual content and final approval of the manuscript.

    • Funding The Department of Cardiology receives unrestricted grants from Biotronik (Berlin, Germany), Boston Scientific (Marlborough, Massachusetts) and Medtronic (Minneapolis, Minnesota).

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval The study was approved by the LUMC ethical committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.