Cherrett Callum, Baker David, Dennis Mark, Kotchetkova Irina, Celermajer David, Cordina Rachael
St Vincent's Hospital, 390 Victoria Street, Darlinghurst, NSW, 2010, Australia.
Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown, NSW, 2050, Australia.
Int J Cardiol Congenit Heart Dis. 2022 Nov 17;11:100427. doi: 10.1016/j.ijcchd.2022.100427. eCollection 2023 Mar.
To compare the late outcomes of adults who underwent atrial switch repair for dextro-transposition of the great arteries, based on their risk profile at age 30 years.
We performed a retrospective study of 67 participants who had undergone atrial switch repair. "Low risk" people were defined as those who reached age 30 years or beyond with normal or mildly impaired systemic right ventricular (RV) function with no or mild tricuspid regurgitation (TR). "High risk" people were defined as those who had moderate or severe systemic RV dysfunction, or moderate or severe tricuspid regurgitation by age 30. The primary outcome was transplant-free survival and the secondary outcome was a composite end-point including hospitalisations for heart failure, inotrope requirement, referral for transplantation and transplantation.
52/67 (78%) were classified as "low risk" and 15/67 (22%) were classified as "high risk". At 45 years, transplant-free survival was 31% for the "high risk" group compared to 87% for "low risk". All "high risk" people met the composite endpoint at 45 years compared to only 18% of the "low risk" group (hazard ratio 6.3, p = 0.03).
Transplant-free survival is markedly reduced in "high risk" atrial switch patients. Risk stratification based on systemic right ventricular function and tricuspid regurgitation at age 30 may predict future health outcomes for atrial switch patients.
根据30岁时的风险状况，比较接受大动脉右转位心房调转术的成年人的远期结局。
我们对67例接受心房调转术的参与者进行了一项回顾性研究。“低风险”人群定义为那些年满30岁及以上，体循环右心室（RV）功能正常或轻度受损，无或仅有轻度三尖瓣反流（TR）的患者。“高风险”人群定义为那些在30岁时出现中度或重度体循环RV功能障碍，或中度或重度三尖瓣反流的患者。主要结局是无移植生存，次要结局是一个复合终点，包括因心力衰竭住院、使用血管活性药物、转诊移植和移植。
67例中有52例（78%）被归类为“低风险”，15例（22%）被归类为“高风险”。在45岁时，“高风险”组的无移植生存率为31%，而“低风险”组为87%。所有“高风险”人群在45岁时均达到复合终点，而“低风险”组仅为18%（风险比6.3，p = 0.03）。
“高风险”心房调转术患者的无移植生存率显著降低。基于30岁时体循环右心室功能和三尖瓣反流的风险分层可能预测心房调转术患者未来的健康结局。
