Arterial Switch for Transposition of the Great Arteries: Treatment Timing, Late Outcomes, and Risk Factors

• Published in: JACC. Advances (Online) Vol. 2; no. 5; p. 100407
• Main Authors: Dorobantu, Dan-Mihai, Espuny Pujol, Ferran, Kostolny, Martin, Brown, Katherine L, Franklin, Rodney C, Crowe, Sonya, Pagel, Christina, Stoica, Serban C
• Format: Journal Article
• Language: English
• Published: United States Elsevier 01-07-2023
• Subjects: Original Research; transposition of the great arteries; arterial switch; multicenter study; reintervention; morbidity; hospital resource utilization; balloon atrial septostomy
• ISSN: 2772-963X; 2772-963X
• DOI: 10.1016/j.jacadv.2023.100407

Reports of long-term mortality and reintervention after transposition of the great arteries with intact ventricular septum treatment, although favorable, are mostly limited to single-center studies. Even less is known about hospital resource utilization (days at hospital) and the impact of treatment choices and timing on outcomes.
The purpose of this study was to describe survival, reintervention and hospital resource utilization after arterial switch operation (ASO) in a national dataset.
Follow-up and life status data for all patients undergoing ASO between 2000 and 2017 in England and Wales were collected and explored using multivariable regressions and matching.
A total of 1,772 patients were identified, with median ASO age of 9.5 days (IQR: 6.5-14.5 days). Mortality and cardiac reintervention at 10 years after ASO were 3.2% (95% CI: 2.5%-4.2%) and 10.7% (95% CI: 9.1%-12.2%), respectively. The median time spent in hospital during the ASO spell was 19 days (IQR: 14, 24). Over the first year after the ASO patients spent 7 days (IQR: 4-10 days) in hospital in total, decreasing to 1 outpatient day/year beyond the fifth year. In a subgroup with complete risk factor data (n = 652), ASO age, and balloon atrial septostomy (BAS) use were not associated with late mortality and reintervention, but cardiac or congenital comorbidities, low weight, and circulatory/renal support at ASO were. After matching for patient characteristics, BAS followed by ASO and ASO as first procedure, performed within the first 3 weeks of life, had comparable early and late outcomes, including hospital resource utilization.
Mortality and hospital resource utilization are low, while reintervention remains relatively frequent. Early ASO and individualized use of BAS allows for flexibility in treatment choices and a focus on at-risk patients.