Long-term follow-up after atrial switch operation for transposition of the great arteries

• Type: Summary of Presentation in an International Conference
• Date: 2012

Authors

Correia AS (Author) Other; Sousa A (Author) Other; Cruz C (Author) Other; Maciel MJ (Author) FMUP

Conference proceedings International

Title: European Journal of Heart Failure Supplements

Initial page: P1295

Heart Failure Congress 2012

Belgrade, 2012

Scientific classification

FOS: Medical and Health sciences > Clinical medicine

Other information

Abstract (EN): Purpose: The atrial switch operation (ASO) for patients presenting with transposition of the great arteries (TGA) was first introduced by Senning in 1959. With improved long-term survival of patients submitted to ASO clinical complications, including arrhythmias, became progressively evident. In this study we aimed to review our experience regarding long-term results, mostly concerning cardiac arrhythmias and need for reoperation. Methods: Retrospective review of the clinical records of adult patients with repaired TGA by ASO followed at an Adult Congenital Heart Disease Clinic in a tertiary care centre. Results: We analyzed 26 patients with TGA submitted to ASO, with a mean follow-up (FU) time of 25±4 years. Mean age at FU was 25±4 years-old and 15 (58%) patients were male. Only one patient underwent a Mustard operation, all the others underwent a Senning operation. All patients had previously undergone balloon atrial septostomy and 4 (15%) also needed a Blalock-Taussig (BT) shunt. Four patients (15%) had TGA associated with a ventricular septal defect, and 4 patients had TGA and a left ventricular outflow tract obstruction (LVOTO). During FU all patients were in NYHA functional class I but only 19 (73%) patients were in sinus rhythm. Three (12%) patients were in permanent junctional rhythm, 1 (3.8%) was in permanent atrial fibrillation and 3 (12%) had a pacemaker rhythm. Arrhythmias occurred in 17 (65%) during FU and increased over time: 3.8% in the first year, 12% at 5 years, 15% at 10 years, 12% at 30 and 12% at 37 years. Sinus node dysfunction was the most frequent rhythm disturbance observed (39%), followed by atrial tachyarrhythmias (19%) including atrial fibrillation, atrial flutter and atrial tachycardia. Two (8%) patients had both sinus node dysfunction and atrial tachyarrhythmias. In four (15%) cases a pacemaker was implanted for severe bradycardia. Reoperation occurred in 2 (8%) patients: 1 for LVOTO (at 12 years of FU) and one for tricuspid valve replacement (at 22 years of FU). Conclusions: Patients who undergo an ASO for TGA have a progressive increase in arrhythmias and loss of sinus rhythm, complications probably related to the atrial surgery and possible damage of the sinus node. However, most patients are in good functional status and reoperations are rare.

Language: English

Type (Professor's evaluation): Scientific

Notes: Correia AS, Sousa A, Cruz C, Maciel MJ. Long-term follow-up after atrial switch operation for transposition of the great arteries. Eur J Heart Fail Suppl 2012; 11(Suppl 1): P1295. ISSN 1567-4215. Heart Failure Congress 2012, Belgrade, 2012