Key result
History of supraventricular tachycardia (OR 3.8; 95% CI 1.4-10.7), Mustard procedure, and complex D-TGA significantly increased the risk of late mortality after atrial switch repair for D-TGA.
Why the study?
Existing data on predictors of late mortality and sudden cardiac death prevention after atrial switch repair for D-TGA are heterogeneous and limited by statistical power.
What are the patient-level predictors of late mortality and sudden cardiac death in patients with D-TGA after atrial switch repair?
Meta-Analysis (n=5,035)
Yes
What are the patient-level predictors of late mortality and sudden cardiac death in patients with D-TGA after atrial switch repair?
Odds Ratio: 3.8 (95% CI 1.4–10.7)
History of supraventricular tachycardia, Mustard procedure, and complex D-TGA significantly increase the risk of late mortality and sudden cardiac death after atrial switch repair, which may help refine ICD patient selection.
May refine ICD selection for D-TGA post-atrial switch; leaves open prospective validation before changing practice.
Background Existing data on predictors of late mortality and prevention of sudden cardiac death after atrial switch repair surgery for D-transposition of the great arteries (D-TGA) are heterogeneous and limited by statistical power. Methods and Results We conducted a systematic review and meta-analysis of 29 observational studies, comprising 5035 patients, that reported mortality after atrial switch repair with a minimum follow-up of 10 years. We also examined 4 additional studies comprising 105 patients who reported rates of implantable cardioverter-defibrillator therapy in this population. Average survival dropped to 65% at 40 years after atrial switch repair, with sudden cardiac death accounting for 45% of all reported deaths. Mortality was significantly lower in cohorts that were more recent and operated on younger patients. Patient-level risk factors for late mortality were history of supraventricular tachycardia (odds ratio [OR] 3.8, 95% CI 1.4-10.7), Mustard procedure compared with Senning (OR 2.9, 95% CI 1.9-4.5) and complex D-TGA compared with simple D-TGA (OR 4.4, 95% CI 2.2-8.8). Significant risk factors for sudden cardiac death were history of supraventricular tachycardia (OR 4.7, 95% CI 2.2-9.8), Mustard procedure (OR 2.2, 95% CI 1.1-4.1), and complex D-TGA (OR 5.7, 95% CI 1.8-18.0). Out of a total 124 implantable cardioverter-defibrillator discharges over 330 patient-years in patients with implantable cardioverter-defibrillators for primary prevention, only 8% were appropriate. Conclusions Patient-level risk of both mortality and sudden cardiac death after atrial switch repair are significantly increased by history of supraventricular tachycardia, Mustard procedure, and complex D-TGA. This knowledge may help refine current selection practices for primary prevention implantable cardioverter-defibrillator implantation, given disproportionately high rates of inappropriate discharges.
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Venkatesh et al. (2019) conducted a meta-analysis in D-transposition of the great arteries after atrial switch repair (n=5,035). History of supraventricular tachycardia vs. No history of supraventricular tachycardia was evaluated on Late mortality (OR 3.8, 95% CI 1.4-10.7). History of supraventricular tachycardia (OR 3.8; 95% CI 1.4-10.7), Mustard procedure, and complex D-TGA significantly increased the risk of late mortality after atrial switch repair for D-TGA.
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