SPC365

Long-term Follow-up Study of Adverse Events after Atrial or Arterial Switch Surgeries for Dextro-Transposition of the Great Arteries

Session: Comunicações Orais - Sessão 07 - Cardiopatias congénitas e Cardiologia pediátrica
Speaker: Catarina Amaral Marques

Congress: CPC 2023
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 20. Congenital Heart Disease and Pediatric Cardiology
Subtheme: 20.7 Pediatric Cardiology
Session Type: Comunicações Orais
FP Number: ---
Authors: Catarina Amaral Marques; Ricardo Alves Pinto; Tânia Proença; Miguel Martins de Carvalho; André Cabrita; Ana Filipa Amador; Catarina Martins da Costa; João Calvão; Luís Daniel Santos; Ana Isabel Pinho; Cátia Oliveira; Pedro Mangas Palma; Helena Santos Moreira; Miguel Rocha; Cristina Cruz

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">Introduction and objectives: </span></strong><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000">Dextro-transposition of the great arteries (D-TGA) is a congenital heart disease (CHD) initially palliated with atrial switch (ATR-S) and more recently</span><span style="color:#008080">&nbsp;</span><span style="color:#000000">repaired with an arterial switch (ART-S). Our aim was to evaluate patients&rsquo; (pts) adverse events after a long-term follow-up (FU).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">Methods: </span></strong><span style="font-family:&quot;Times New Roman&quot;,serif">Retrospective analysis<strong> </strong>of D-TGA pts born between 1974 and 2001 and followed in Adult CHD Outpatient Clinic at a tertiary care hospital. Data was collected by reviewing medical records. Time-to-event analysis was performed. Adverse events were defined as a composite of death, stroke, coronary revascularization, arrhythmia and ventricular, baffle or significant valvular dysfunction. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">Results: </span></strong><span style="color:#000000; font-family:&quot;Times New Roman&quot;,serif">79 pts were enrolled with a mean follow-up time after surgery of 27&plusmn;6 years. Pts median age was 27 years-old and 46% were female. ATR-S was performed in 54%, while 46% underwent ART-S. </span><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000">Concerning post-switch complications,</span><span style="color:#ff0000">&nbsp;</span><span style="color:#000000">systemic ventricle systolic dysfunction (SVSD) occurred only in ATR-S pts (41% vs 0%, p&lt;0.001); subpulmonic ventricle dysfunction (SPVD) was a rare event in both groups; the most frequent complication after ART-S was significant systemic ventriculoarterial</span>&nbsp;<span style="color:#000000">(VA</span><span style="color:#000000">) valve regurgitation, though no significant differences between groups were found (7% ATR-S vs 14% ART-S; p=0.459); only 1 ART-S presented neoaortic root dilation and 2 ATR-S developed baffle dysfunction.&nbsp;</span></span></span></span><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-family:&quot;Times New Roman&quot;,serif">Regarding long-term outcomes, 1 ATR-S and 3 ART-S pts were submitted to surgical coronary revascularization (p=0.325); 1 patient in each group had a stroke (p=0.725); no ART-S pts died during FU and only 1 ATR-S died due to baffle dysfunction (p=1).&nbsp;</span></span></span></span><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-family:&quot;Times New Roman&quot;,serif">Regarding time-to-event analysis, 80% and 40% of ATR-S pts were free from adverse-events after 20 and 30 years, respectively; the mean time to first adverse-event was 23&plusmn;8 years and no significant differences were found between groups (Log-rank=0.596, Figure 1). </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusion: </span></strong><span style="font-family:&quot;Times New Roman&quot;,serif">In our study,<strong> </strong>SVSD and </span><span style="font-family:&quot;Times New Roman&quot;,serif">baffle dysfunction were found in ATR-S pts, highlighting the advantage of performing ART-S<u><span style="color:teal"> </span></u>over ATR-S. In ART-S pts, the most common complication </span><span style="font-family:&quot;Times New Roman&quot;,serif">was systemic VA&nbsp;valve regurgitation, even though no significant differences were found to ATR-S. </span><span style="font-family:&quot;Times New Roman&quot;,serif">Aortic root dilatation was a rare complication and coronary revascularization was equally performed in both groups. After a long-term free of adverse-events, ATR-S patients experienced significantly more SVSD, while ART-S complications were predominantly anastomosis related.</span></span></span></span></p>