| Autor: |
Woudstra OI; Department of Clinical and Experimental Cardiology Heart Center Amsterdam Cardiovascular SciencesAmsterdam University Medical CenterUniversity of Amsterdam the Netherlands.; Department of Cardiology University Medical Center Utrecht Utrecht the Netherlands., Zandstra TE; Department of Cardiology Leiden University Medical Center Leiden the Netherlands., Vogel RF; Department of Clinical and Experimental Cardiology Heart Center Amsterdam Cardiovascular SciencesAmsterdam University Medical CenterUniversity of Amsterdam the Netherlands., van Dijk APJ; Department of Cardiology Radboud University Medical Center Nijmegen the Netherlands., Vliegen HW; Department of Cardiology Leiden University Medical Center Leiden the Netherlands., Kiès P; Department of Cardiology Leiden University Medical Center Leiden the Netherlands., Jongbloed MRM; Department of Cardiology Leiden University Medical Center Leiden the Netherlands.; Department of Anatomy and Embryology Leiden University Medical Center Leiden the Netherlands., Egorova AD; Department of Cardiology Leiden University Medical Center Leiden the Netherlands., Doevendans PAFM; Department of Cardiology University Medical Center Utrecht Utrecht the Netherlands., Konings TC; Department of Clinical and Experimental Cardiology Heart Center Amsterdam Cardiovascular SciencesAmsterdam University Medical CenterVrije Universiteit Amsterdam Amsterdam the Netherlands., Mulder BJM; Department of Clinical and Experimental Cardiology Heart Center Amsterdam Cardiovascular SciencesAmsterdam University Medical CenterUniversity of Amsterdam the Netherlands., Tanck MWT; Department of Clinical Epidemiology, Biostatistics and Bioinformatics Amsterdam University Medical CenterUniversity of Amsterdam the Netherlands., Meijboom FJ; Department of Cardiology University Medical Center Utrecht Utrecht the Netherlands., Bouma BJ; Department of Clinical and Experimental Cardiology Heart Center Amsterdam Cardiovascular SciencesAmsterdam University Medical CenterUniversity of Amsterdam the Netherlands. |
| Abstrakt: |
Background Patients with transposition of the great arteries corrected by an atrial switch operation experience major clinical events during adulthood, mainly heart failure (HF) and arrhythmias, but data on the emerging risks remain scarce. We assessed the risk for events during the clinical course in adulthood, and provided a novel risk score for event-free survival. Methods and Results This multicenter study observed 167 patients with transposition of the great arteries corrected by an atrial switch operation (61% Mustard procedure; age, 28 [interquartile range, 24-36] years) for 13 (interquartile range, 9-16) years, during which 16 (10%) patients died, 33 (20%) had HF events, defined as HF hospitalizations, heart transplantation, ventricular assist device implantation, or HF-related death, and 15 (9%) had symptomatic ventricular arrhythmias. Five-year risk of mortality, first HF event, and first ventricular arrhythmia increased from 1% each at age 25 years, to 6% (95% CI, 4%-9%), 23% (95% CI, 17%-28%), and 5% (95% CI, 2%-8%), respectively, at age 50 years. Predictors for event-free survival were examined to construct a prediction model using bootstrapping techniques. A prediction model combining age >30 years, prior ventricular arrhythmia, age >1 year at repair, moderate or greater right ventricular dysfunction, severe tricuspid regurgitation, and mild or greater left ventricular dysfunction discriminated well between patients at low (<5%), intermediate (5%-20%), and high (>20%) 5-year risk (optimism-corrected C-statistic, 0.86 [95% CI, 0.82-0.90]). Observed 5- and 10-year event-free survival rates in low-risk patients were 100% and 97%, respectively, compared with only 31% and 8%, respectively, in high-risk patients. Conclusions The clinical course of patients undergoing atrial switch increasingly consists of major clinical events, especially HF. A novel risk score stratifying patients as low, intermediate, and high risk for event-free survival provides information on absolute individual risks, which may support decisions for pharmacological and interventional management. |
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