Long-term outcome and quality of life after arterial switch operation: a prospective study with a historical comparison

Congenit Heart Dis. May-Jun 2013;8(3):203-10. doi: 10.1111/chd.12033. Epub 2013 Jan 28.

Abstract

AIM.: The study aims to describe the long-term cardiological and psychological results of our first surgical cohort of arterial switch operation (ASO) patients and compare the results with our earlier series of Mustard patients. METHODS.: Twenty-four survivors of ASO operated in our center (1985-1990) were evaluated by electrocardiography, echocardiography, magnetic resonance imaging, exercise testing, 24-hour Holter-monitoring, and health-related quality of life questionnaire. The results were compared with 58 adult Mustard patients who were evaluated in 2001 using the same study protocol. RESULTS.: Arterial switch operation was performed at a median age of 13 days and Mustard operation at 2 years. Median follow-up was 22 years (range 20-25) and 25 years (22-29), respectively. After ASO, survival was better (P =.04). The event-free survival after 22 years was 77% after ASO vs. 44% after Mustard (P =.03). Good systemic ventricular function was present in 93% after ASO vs. 6% after Mustard (P <.01). Exercise capacity in ASO was 85% of predicted, compared with 72% in Mustard patients (P =.01). Aortic regurgitation was found in 21% of ASO patients vs. 16% in Mustard patients. Arterial switch patients vs. Mustard patients reported significantly better quality of life and less somatic complaints. CONCLUSION.: The progression made in surgical treatment for transposition of the great arteries from Mustard to ASO has had a positive impact on survival, cardiac function, exercise capacity, and also self-reported quality of life and somatic complaints. Longer follow-up is warranted to monitor aortic regurgitation.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aortic Valve Insufficiency / etiology
  • Aortic Valve Insufficiency / psychology
  • Cardiac Surgical Procedures* / adverse effects
  • Cardiac Surgical Procedures* / mortality
  • Cardiac Surgical Procedures* / psychology
  • Child, Preschool
  • Disease-Free Survival
  • Echocardiography
  • Electrocardiography, Ambulatory
  • Exercise Test
  • Exercise Tolerance
  • Female
  • Humans
  • Infant, Newborn
  • Kaplan-Meier Estimate
  • Magnetic Resonance Imaging
  • Male
  • Netherlands
  • Predictive Value of Tests
  • Prospective Studies
  • Quality of Life*
  • Recovery of Function
  • Surveys and Questionnaires
  • Time Factors
  • Transposition of Great Vessels / mortality
  • Transposition of Great Vessels / physiopathology
  • Transposition of Great Vessels / psychology
  • Transposition of Great Vessels / surgery*
  • Treatment Outcome
  • Ventricular Function
  • Young Adult