Follow up after atrial switch surgery in patients with transposition of the great arteries; reality versus guidelines

Atrial switch surgery, previously the intervention of choice for transposition of the great arteries, has been superseded by the arterial switch operation. The cohorts of patients who received atrial switch operations remain at risk of complications including sudden cardiac death, heart failure, and arrhythmias and require lifelong monitoring. The American Heart Association issued guidance in 2018 about how follow up should be undertaken. We sought to compare the follow up regime suggested by these, and the European Society of Cardiology guidelines to the reality of that achieved in a specialist ACHD centre. Patients under follow up after atrial switch surgery at a Level 1 centre were identified; demographic and clinical data were collected. Timeframes of follow up were compared to those suggested by the guidelines. We identified 110 patients following atrial switch surgery. At the end of the study period 94 patients (median age 41, IQR 11), remained under follow up. There were 16 patients whom had either died or undergone transplantation. Over two-thirds (65,69%) received a specialist clinic review within the recommended timeframe. Almost one fifth, 17 patients (18%) underwent cardiac magnetic resonance imaging within the recommended timeframe. Our results show that achieving the recommended timeframes for patient follow up following atrial switch surgery is challenging in real life clinical practice. Future studies are needed to provide evidence for optimal follow up intervals that result in improvements in patient outcomes, given the cost and resource implications of these enhanced follow up regimes.