Slow progress to heart failure, death seen in patients with d-TGA after atrial switch

Most adults with d-loop transposition of the great arteries (d-TGA) after atrial switch operation exhibit slow progression to end-stage heart failure or death, according to a recent study.

“A simplified prediction score for 5-year adverse outcome is derived to help identify those at greatest risk,” the investigators said.

A multicentre, retrospective cohort study was conducted involving adults with d-TGA and prior atrial switch surgery seen at a congenital heart centre. The investigators obtained clinical data from initial and most recent visits. The primary outcome was the composite of death, transplantation, or mechanical circulatory support (MCS).

A total of 1,168 patients (age at first visit 29 years, 38 percent female) were followed for a median of 9.2 years. Of these, 91 (8.8 percent per 10 person-years) met the primary outcome (66 deaths, 19 transplantations, and six MCS).

Patients who had sudden/arrhythmic death were younger than those who died of other causes (32.6 vs 42.4 years; p<0.001). A long duration was observed between sentinel clinical events and end-stage heart failure. Of note, the following factors correlated with the primary outcome: age, atrial arrhythmia, pacemaker, biventricular enlargement, systolic dysfunction, and tricuspid regurgitation.

Moreover, prior ventricular arrhythmia, heart failure admission, complex anatomy, QRS duration >120 ms, and severe right ventricle dysfunction based on echocardiography independently predicted the primary outcome within 5 years.