Congenitally corrected transposition of the great arteries: Ventricular function at the time of systemic atrioventricular valve replacement predicts long-term ventricular function

Franois Pierre Mongeon, Heidi M. Connolly, Joseph A. Dearani, Zhuo Li, Carole A. Warnes

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2008-2017
Number of pages10
JournalJournal of the American College of Cardiology
Volume57
Issue number20
DOIs
StatePublished - May 17 2011

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Ventricular Function
Stroke Volume
Ventricular Pressure
Congenitally corrected transposition of the great arteries
Blood Pressure
Atrial Fibrillation
Heart Ventricles

Keywords

  • congenitally corrected transposition of the great arteries
  • ejection fraction
  • pulmonary pressure
  • tricuspid valve replacement
  • ventricular function

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Congenitally corrected transposition of the great arteries : Ventricular function at the time of systemic atrioventricular valve replacement predicts long-term ventricular function. / Mongeon, Franois Pierre; Connolly, Heidi M.; Dearani, Joseph A.; Li, Zhuo; Warnes, Carole A.

In: Journal of the American College of Cardiology, Vol. 57, No. 20, 17.05.2011, p. 2008-2017.

Research output: Contribution to journalArticle

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abstract = "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.",
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AU - Dearani, Joseph A.

AU - Li, Zhuo

AU - Warnes, Carole A.

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