Open AccessPredictors of Late Mortality in D‐Transposition of the Great Arteries After Atrial Switch Repair: Systematic Review and Meta‐Analysis
Author(s) -
Venkatesh Prashanth,
Evans Arthur T.,
Maw Anna M.,
Pashun Raymond A.,
Patel Agam,
Kim Luke,
Feldman Dmitriy,
Minutello Robert,
Wong S. Chiu,
Stribling Judy C.,
LaPar Damian,
Holzer Ralf,
Ginns Jonathan,
Bacha Emile,
Singh Harsimran S.
Publication year - 2019
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.119.012932
Subject(s) - medicine , supraventricular tachycardia , cardiology , great arteries , implantable cardioverter defibrillator , odds ratio , atrial fibrillation , population , ventricular tachycardia , meta analysis , surgery , heart disease , tachycardia , environmental health
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‐defibrillator s 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.