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

Research output: Contribution to journalArticlepeer-review

Authors

  • Jake Williams
  • S. Arif
  • S. Bowater
  • S. Thorne
  • Paul Clift
  • Lucy Hudsmith

Colleges, School and Institutes

Abstract

Introduction
Atrial switch surgery, previously the intervention of choice for transposition of the great arteries, has been superseded by the arterial switch operation.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.

Methods
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.

Results
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.

Conclusion
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.

Bibliographic note

Financial support: Dr Stoll is funded by the National Institute of Health Research as a Clinical Lecturer.

Details

Original languageEnglish
Article number100123
JournalInternational Journal of Cardiology Congenital Heart Disease
Volume3
Early online date27 Mar 2021
Publication statusPublished - May 2021

Keywords

  • transposition of the great arteries, atrial switch, guidelines, follow up