TY - JOUR
T1 - Congenitally corrected transposition of the great arteries
T2 - Ventricular function at the time of systemic atrioventricular valve replacement predicts long-term ventricular function
AU - Mongeon, Franois Pierre
AU - Connolly, Heidi M.
AU - Dearani, Joseph A.
AU - Li, Zhuo
AU - Warnes, Carole A.
N1 - Funding Information:
Dr. Mongeon is currently affiliated with the Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montréal, Canada. Dr. Mongeon is supported by the Bourse du Coeur 2009 scholarship from the Montreal Heart Institute Foundation. All other authors have reported that they have no relationships to disclose.
PY - 2011/5/17
Y1 - 2011/5/17
N2 - Objectives: The objective was to evaluate the systemic ventricular ejection fraction (SVEF) at the time of systemic atrioventricular valve (SAVV) replacement as a predictor of SVEF ≥1 year after surgery in patients with congenitally corrected transposition of the great arteries (CCTGA). Background: Progressive SAVV regurgitation causes systemic ventricular failure in CCTGA patients, who are commonly referred late for intervention. Survival after surgery is poor when the pre-operative SVEF is <44%. Methods: We retrospectively reviewed 46 patients (pre-operative SVEF ≥40% in 27 patients and <40% in 19 patients) with 2 good-sized ventricles, a morphologically right systemic ventricle, and SAVV regurgitation requiring surgery. Median follow-up was not different in patients with a pre-operative SVEF ≥40% (8.8 years) or <40% (7.7 years, p = 0.36). Results: Pre-operative SVEF was the only independent predictor of ≥1-year post-operative SVEF (p < 0.0001). The late SVEF was preserved (defined as ≥40%) in 63% of patients who underwent surgery with an SVEF <40% compared with 10.5% of patients who underwent surgery with an SVEF <40%. Pre-operative variables associated with late mortality were an SVEF ≤40%, a subpulmonary ventricular systolic pressure ≥50 mm Hg, atrial fibrillation, and New York Heart Association functional class III to IV. Conclusions: Post-operative systemic ventricular function after SAVV replacement can be predicted from the pre-operative SVEF. For best results, operation should be considered at an earlier stage, before the SVEF falls below 40% and the subpulmonary ventricular systolic pressure rises above 50 mm Hg.
AB - Objectives: The objective was to evaluate the systemic ventricular ejection fraction (SVEF) at the time of systemic atrioventricular valve (SAVV) replacement as a predictor of SVEF ≥1 year after surgery in patients with congenitally corrected transposition of the great arteries (CCTGA). Background: Progressive SAVV regurgitation causes systemic ventricular failure in CCTGA patients, who are commonly referred late for intervention. Survival after surgery is poor when the pre-operative SVEF is <44%. Methods: We retrospectively reviewed 46 patients (pre-operative SVEF ≥40% in 27 patients and <40% in 19 patients) with 2 good-sized ventricles, a morphologically right systemic ventricle, and SAVV regurgitation requiring surgery. Median follow-up was not different in patients with a pre-operative SVEF ≥40% (8.8 years) or <40% (7.7 years, p = 0.36). Results: Pre-operative SVEF was the only independent predictor of ≥1-year post-operative SVEF (p < 0.0001). The late SVEF was preserved (defined as ≥40%) in 63% of patients who underwent surgery with an SVEF <40% compared with 10.5% of patients who underwent surgery with an SVEF <40%. Pre-operative variables associated with late mortality were an SVEF ≤40%, a subpulmonary ventricular systolic pressure ≥50 mm Hg, atrial fibrillation, and New York Heart Association functional class III to IV. Conclusions: Post-operative systemic ventricular function after SAVV replacement can be predicted from the pre-operative SVEF. For best results, operation should be considered at an earlier stage, before the SVEF falls below 40% and the subpulmonary ventricular systolic pressure rises above 50 mm Hg.
KW - congenitally corrected transposition of the great arteries
KW - ejection fraction
KW - pulmonary pressure
KW - tricuspid valve replacement
KW - ventricular function
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U2 - 10.1016/j.jacc.2010.11.021
DO - 10.1016/j.jacc.2010.11.021
M3 - Article
C2 - 21565637
AN - SCOPUS:79955851321
SN - 0735-1097
VL - 57
SP - 2008
EP - 2017
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 20
ER -