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Background: In the 1980's the preferred surgery for d-transposition of the great arteries (TGA) shifted from the atrial switch operation to the arterial switch operation (ASO). However, the long-term survival from ASO is unclear. Our objective was to compare transplant-free survival in patients with ASO vs. atrial switch.
Methods: We performed a retrospective cohort study of patients with TGA repair in the Pediatric Cardiac Care Consortium registry from 1982-1991 whose outcomes had been linked with the National Death Index and United Network for Organ Sharing. Kaplan Meier transplant-free survival curves and hazard of mortality/transplant were calculated for each group.
Results: Among the 342 patients with atrial switch and 235 patients with ASO, 20-year transplant-free survival was significantly greater in the ASO group (log-rank p=0.019, Figure), with the atrial switch cohort having a hazard of mortality/transplant of 1.58 compared to the ASO cohort (95% CI: 1.07-2.34, p=0.021). Presence of a ventricular septal defect was associated with a significantly increased hazard of mortality/transplant in the atrial switch group (2.04; 95% CI: 1.27-3.29, p=0.003) but not in the ASO group (1.54; 95% CI: 0.80-3.00, p=0.199). There was no significantly increased risk in patients with genetic defects in either group.
Conclusions: Long-term transplant-free survival for patients with TGA is superior with ASO compared to atrial switch. In-depth analysis is underway to determine causes of death in these patients.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Congenital Heart Disease Surgery: Updates and Innovations
Abstract Category: 11. Congenital Heart Disease: Therapy
Presentation Number: 1272-021
- 2017 American College of Cardiology Foundation