Long-Term Survival After Arterial Versus Atrial Switch in d-Transposition of the Great Arteries

• Type of Material: Article
• Authors: Alex Kiener, Emory University; Michael Kelleman, Emory University; Courtney McCracken, Emory University; Lazaros Kochilas, Emory University; James D. St Louis, University of Missouri Kansas City; Matthew Oster, Emory University
• Language: English
• Date: 2018-12-01
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 The Society of Thoracic Surgeons
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.athoracsur.2018.06.084
• Title of Journal or Parent Work: ANNALS OF THORACIC SURGERY
• Volume: 106
• Issue: 6
• Start Page: 1827
• End Page: 1833
• Keywords: Science & Technology; Life Sciences & Biomedicine; OPERATION; Surgery; SURGERY; OUTCOMES; ANATOMIC CORRECTION; Respiratory System; Cardiovascular System & Cardiology; VESSELS; Cardiac & Cardiovascular Systems
• Research Categories: Health Sciences, Medicine and Surgery; Biology, Anatomy; Biology, Cell

Abstract

Background: The arterial switch operation (ASO) became the procedure of choice for dextro-transposition of the great arteries (d-TGA) nearly 30 years ago, but the long-term results of this operation are unknown. We aimed to compare the long-term transplant-free survival of patients with d-TGA who underwent ASO versus atrial switch in the Pediatric Cardiac Care Consortium. Methods: We performed a retrospective cohort study of d-TGA patients undergoing ASO or atrial switch in the United States between 1982 and 1991. Long-term transplant-free survival was obtained by linking Pediatric Cardiac Care Consortium data with the National Death Index and the Organ Procurement and Transplant Network. Kaplan-Meier survival plots were constructed, and multivariable regression was used to compare long-term transplant-free survival. Results: Of 554 d-TGA patients who underwent ASO (n = 259) or atrial switch (n = 295), the 20-year overall transplant-free survival was 82.1% for those undergoing ASO and 76.3% for those who had atrial switch procedure. Adjusted overall transplant-free survival beyond 10 years after operation was superior for ASO compared with atrial switch (hazard ratio 0.07, 95% confidence interval: 0.01 to 0.52, p = 0.009). During this period, the ASO had higher in-hospital mortality than the atrial switch (21.6% versus 12.9%, p = 0.007). After excluding patients with in-hospital mortality, the transplant-free survival 20 years after repair was 97.7% for the ASO patients versus 86.3% for the atrial switch patients. Conclusions: Despite initial higher in-hospital mortality for ASO during the study period, there is a significant long-term transplant-free survival advantage for ASO as compared with atrial switch for d-TGA surgery. Ongoing monitoring is required to assess late risk of cardiovascular disease.