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Congenital heart disease
Original research
Predictors of mortality after atrial correction of transposition of the great arteries
  1. Petra Antonová1,
  2. Vilem Rohn1,
  3. Vaclav Chaloupecky2,
  4. Iveta Simkova3,
  5. Monika Kaldararova3,
  6. Jan Zeman4,
  7. Jana Popelova5,
  8. Mariia Havova1,
  9. Jan Janousek2
  1. 1 Cardiovascular Surgery, Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
  2. 2 Children's Heart Center, Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
  3. 3 National Institute of Cardiovascular Diseases, Univerzitna Nemocnica Bratislava, Bratislava, Slovakia
  4. 4 Internal Medicine, University of Connecticut, Farmington, Connecticut, USA
  5. 5 Cardiovascular Surgery, Nemocnice na Homolce, Prague, Czech Republic
  1. Correspondence to Dr Petra Antonová, Department of cardiovascular surgery, Fakultni nemocnice v Motole, Praha 5, 150 08, Czech Republic; petra.antonova{at}fnmotol.cz

Abstract

Objectives To determine the long-term and transplantation-free survival of all patients after atrial correction of transposition of the great arteries (TGA) in the Czech and Slovak republics, including its preoperative and perioperative determinants.

Methods Retrospective analysis of all 454 consecutive patients after atrial correction of TGA was performed. Of these, 126 (27.8%) were female, median age at operation was 7.4 months (Q1 5.3; Q3 13.3) and 164 (36.1%) underwent the Mustard procedure. The relationships between age, weight, the complexity of TGA, operative technique, additional surgical procedures, immediate postoperative presence of tricuspid regurgitation and revision procedures during follow-up to major composite outcome, as such defined as long-term and transplantation-free survival, were tested.

Results Early 30-day mortality did not differ between the Mustard (9.76%) and Senning (8.97%) cohorts (p=0.866). The long-term and transplantation-free survival, which differed between the Mustard and Senning cohorts in favour of the Senning procedure (HR 0.43; 95% CI 0.21 to 0.87), was shorter in complex TGA (HR 2.4; 95% CI 1.59 to 3.78) and in complex surgical interventions (HR 3.51; 95% CI 2.31 to 5.56). The immediate presence of at least moderate tricuspid regurgitation after correction was associated with a shorter long-term and transplantation-free survival in the univariate but not in the multivariable model.

Conclusions The lower long-term survival of patients after an atrial switch operation of TGA in the Czech and Slovak republics is associated with greater complexity of TGA, complex surgical interventions and application of the the Mustard operative procedure.

  • transposition of great vessels
  • heart defects, congenital
  • tricuspid valve insufficiency

Data availability statement

Data are available on reasonable request.

https://doi.org/10.1136/heartjnl-2021-320035

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    Data availability statement

    Data are available on reasonable request.

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    Footnotes

    • Collaborators The authors would like to thank Vaclav Capek for his contribution to this manuscript.

    • Contributors All the authors contributed to the planning of the study, patient identification, data collection, data reporting and writing. Similarly, they were all involved in the interpretation of the results and the revision of the manuscript. PA and JJ are the guarantors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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