Decreased clinical performance in TGA-ASO patients after RVOT interventions; a multicenter European collaboration

• DOI: 10.1016/j.ijcard.2024.132027
• Publication Date: 2024-04-05T22:27:44Z
• Authors: Leo J. Engele; Víctor González-F...; Barbara J.M. Mulder; Francisco Javier ...; Raquel Ladrón Abia; Kim van der Vlist; Francisco Buendía; Joaquin Rueda; Harald Gabriel; Lore Schrutka; Judith Bouchardy; Markus Schwerzmann; Mathias Possner; Matthias Greutmann; Pastora Gallego; Magalie Ladouceur; Monique R.M. Jong...; Daniel Tobler; Laura Dos; Berto J. Bouma
• Keywords: Peak-VO2; Right ventricular outflow tract obstruction; Re-intervention; Arterial switch operation; 10209 Clinic for Cardiology; Transposition of the great arteries; 610 Medicine & health; 2705 Cardiology and Cardiovascular Medicine; Humans; Male; Female; Transposition of Great Vessels/surgery; Transposition of Great Vessels/physiopathology; Adult; Young Adult; Europe/epidemiology; Ventricular Outflow Obstruction/surgery; Ventricular Outflow Obstruction/physiopathology; Ventricular Outflow Obstruction/diagnostic imaging; Arterial Switch Operation/methods; Arterial Switch Operation/adverse effects; Exercise Tolerance/physiology; Exercise Test/methods; Treatment Outcome; Ventricular Function, Right/physiology; Follow-Up Studies; Arterial switch operation; Peak-VO2; Re-intervention; Right ventricular outflow tract obstruction; Transposition of the great arteries

In patients with transposition of the great arteries and an arterial switch operation (TGA-ASO) right ventricular outflow tract (RVOT) obstruction is a common complication requiring one or more RVOT interventions.We aimed to assess cardiopulmonary exercise capacity and right ventricular function in patients stratified for type of RVOT intervention.TGA-ASO patients (≥16 years) were stratified by type of RVOT intervention. The following outcome parameters were included: predicted (%) peak oxygen uptake (peak VO2), tricuspid annular plane systolic excursion (TAPSE), tricuspid Lateral Annular Systolic Velocity (TV S'), right ventricle (RV)-arterial coupling (defined as TAPSE/RV systolic pressure ratio), and NT-pro-BNP.447 TGA patients with a mean age of 25.0 (interquartile range (IQR) 21-29) years were included. Patients without previous RVOT intervention (n = 338, 76%) had a significantly higher predicted peak VO2 (78.0 ± 17.4%) compared to patients with single approach catheter-based RVOT intervention (73.7 ± 12.7%), single approach surgical RVOT intervention (73.8 ± 28.1%), and patients with multiple approach RVOT intervention (66.2 ± 14.0%, p = 0.021). RV-arterial coupling was found to be significantly lower in patients with prior catheter-based and/or surgical RVOT intervention compared to patients without any RVOT intervention (p = 0.029).TGA patients after a successful arterial switch repair have a decreased exercise capacity. A considerable amount of TGA patients with either catheter or surgical RVOT intervention perform significantly worse compared to patients without RVOT interventions.