Cognitive outcomes and health-related quality of life in adults two decades after the arterial switch operation for transposition of the great arteries

Abstract

Objective: The study objective was to evaluate the cognitive and psychosocial outcomes of young adults who underwent an arterial switch operation for transposition of the great arteries.

Methods: Sixty-seven adults with transposition of the great arteries (aged 22.9 ± 3.3 years) and 43 healthy subjects matched in age, gender, and educational level participated. Global cognitive functioning, psychologic state, and health-related quality of life were evaluated using validated tools. We analyzed patient-related and procedure-related risk factors associated with cognitive and psychosocial outcomes.

Results: Some 69% of patients had an intelligence quotient greater than 85 (normal range, 85-115). Mean full-scale, verbal, and performance intelligence quotients were lower in patients (94.9 ± 15.3, 96.8 ± 16.2, 93.7 ± 14.6, respectively) than in healthy subjects (103.4 ± 12.3, P = .003; 102.5 ± 11.5, P = .033; 103.8 ± 14.3, P < .001, respectively). Cognitive difficulties (intelligence quotient ≤-1 standard deviation) and impairments (intelligence quotient ≤-2 standard deviations) were more frequent in patients than in the general population (31% vs 16%, P = .001; 6% vs 2%, P = .030). Patients with cognitive difficulties had lower educational level (P < .001) and more grade retention at school (P = .007). Patients reported an overall satisfactory health-related quality of life; however, those with cognitive or psychologic difficulties reported poorer quality of life. Predictors of worse outcomes included lower parental socioeconomic and educational status, older age at surgery, and longer hospitalization stay.

Conclusions: Despite satisfactory outcomes in most adults with transposition of the great arteries, a substantial proportion has cognitive or psychologic difficulties that may reduce their academic success and quality of life. Further studies are needed to better understand the long-term outcome of this population to provide prevention, surveillance, and care strategies.

Keywords: arterial switch operation; cognitive outcomes; early adulthood; health-related quality of life; transposition of the great arteries.