Frederik Helsen1, Pieter De Meester1, Jan Van Keer2, Charlien Gabriels1, Alexander Van De Bruaene2, Paul Herijgers3, Filip Rega4, Bart Meyns4, Marc Gewillig5, Els Troost2, Werner Budts6. 1. Division of Cardiology, Department of Cardiovascular Sciences, KU Leuven - University of Leuven, B-3000 Leuven, Belgium; Department of Cardiology, University Hospitals Leuven, B-3000 Leuven, Belgium. 2. Department of Cardiology, University Hospitals Leuven, B-3000 Leuven, Belgium. 3. Division of Experimental Cardiac Surgery, Department of Cardiovascular Sciences, KU Leuven - University of Leuven, B-3000 Leuven, Belgium; Department of Cardiac Surgery, University Hospitals Leuven, B-3000 Leuven, Belgium. 4. Department of Cardiac Surgery, University Hospitals Leuven, B-3000 Leuven, Belgium; Division of Clinical Cardiac Surgery, Department of Cardiovascular Sciences, KU Leuven - University of Leuven, B-3000 Leuven, Belgium. 5. Division of Cardiovascular Developmental Biology, Department of Cardiovascular Sciences, KU Leuven - University of Leuven, B-3000 Leuven, Belgium; Department of Paediatrics, University Hospitals Leuven, B-3000 Leuven, Belgium. 6. Division of Cardiology, Department of Cardiovascular Sciences, KU Leuven - University of Leuven, B-3000 Leuven, Belgium; Department of Cardiology, University Hospitals Leuven, B-3000 Leuven, Belgium. Electronic address: werner.budts@uzleuven.be.
Abstract
BACKGROUND: Pulmonary outflow tract obstruction (POTO) reduces systemic atrioventricular valve (SAVV) regurgitation severity in congenitally corrected transposition of the great arteries (ccTGA). Therefore, pulmonary artery banding is proposed as a palliative intervention. We aimed to investigate the effect of native or surgically induced POTO on event-free survival, defined as the composite of all-cause mortality, heart transplantation, or congestive heart failure (CHF). METHODS AND RESULTS: Patients with ccTGA (n=62; median age 27.5 (IQR 18.4-39.4) years; 39% with POTO) were selected from the Adult Congenital Heart Disease database of a tertiary hospital. At first visit, SAVV regurgitation ≥ 3/4, systemic RV dysfunction ≥ moderate, and CHF were present in 26%, 26%, and 15% of patients, respectively. Over a mean follow-up time of 10.1 ± 6.1 years, all-cause mortality, rate of heart transplantation, and CHF were 18%, 8% and 40%, respectively. SAVV regurgitation (HR: 1.99; 95% CI: 1.01-3.92; P=0.048) and systemic RV dysfunction severity (HR: 1.89; 95% CI: 1.05-3.37; P=0.033) were associated with the composite endpoint, independently of age at baseline, POTO, Ebstein-like malformation, and systemic RV dilatation. Patients with POTO had lower risk for developing SAVV regurgitation ≥ 3/4 (HR: 0.18; 95% CI: 0.05-0.58; P=0.004) and moderate systemic RV dysfunction (HR: 0.34; 95% CI: 0.15-0.78; P=0.011). When POTO was present, the mean progression-free interval for the composite endpoint increased from 11.2 to 18.1 years (P=0.035). CONCLUSIONS: POTO is associated with an improved event-free survival in adults with ccTGA.
BACKGROUND:Pulmonary outflow tract obstruction (POTO) reduces systemic atrioventricular valve (SAVV) regurgitation severity in congenitally corrected transposition of the great arteries (ccTGA). Therefore, pulmonary artery banding is proposed as a palliative intervention. We aimed to investigate the effect of native or surgically induced POTO on event-free survival, defined as the composite of all-cause mortality, heart transplantation, or congestive heart failure (CHF). METHODS AND RESULTS:Patients with ccTGA (n=62; median age 27.5 (IQR 18.4-39.4) years; 39% with POTO) were selected from the Adult Congenital Heart Disease database of a tertiary hospital. At first visit, SAVV regurgitation ≥ 3/4, systemic RV dysfunction ≥ moderate, and CHF were present in 26%, 26%, and 15% of patients, respectively. Over a mean follow-up time of 10.1 ± 6.1 years, all-cause mortality, rate of heart transplantation, and CHF were 18%, 8% and 40%, respectively. SAVV regurgitation (HR: 1.99; 95% CI: 1.01-3.92; P=0.048) and systemic RV dysfunction severity (HR: 1.89; 95% CI: 1.05-3.37; P=0.033) were associated with the composite endpoint, independently of age at baseline, POTO, Ebstein-like malformation, and systemic RV dilatation. Patients with POTO had lower risk for developing SAVV regurgitation ≥ 3/4 (HR: 0.18; 95% CI: 0.05-0.58; P=0.004) and moderate systemic RV dysfunction (HR: 0.34; 95% CI: 0.15-0.78; P=0.011). When POTO was present, the mean progression-free interval for the composite endpoint increased from 11.2 to 18.1 years (P=0.035). CONCLUSIONS: POTO is associated with an improved event-free survival in adults with ccTGA.
Authors: Alexander Van De Bruaene; Lukas Meier; Walter Droogne; Pieter De Meester; Els Troost; Marc Gewillig; Werner Budts Journal: Heart Fail Rev Date: 2018-01 Impact factor: 4.214
Authors: Fernando Amaral; Anne Marie Valente; Paulo Henrique Manso; Luiz Gustavo Gali; Maria Fernanda Braggion-Santos; Julia Mignot Rocha; Walter Vilella de Andrade Vicente; André Schmidt Journal: Braz J Cardiovasc Surg Date: 2022-08-16