Pulmonary outflow obstruction protects against heart failure in adults with congenitally corrected transposition of the great arteries

Int J Cardiol. 2015 Oct 1;196:1-6. doi: 10.1016/j.ijcard.2015.05.142. Epub 2015 May 28.

Pulmonary outflow obstruction protects against heart failure in adults with congenitally corrected transposition of the great arteries.

Helsen F1De Meester P1Van Keer J2Gabriels C1Van De Bruaene A2Herijgers P3Rega F4Meyns B4Gewillig M5Troost E2Budts W6.

Comment: Previous studies revealed that pulmonary outflow tract obstruction (POTO) reduces systemic AV valve regurgitation in adults with congenitally corrected transposition of the great arteries (ccTGA). The aim of this study was to determine the impact of native or surgically induced POTO on event-free survival. At first visit, ventricular function, systemic AV valve regurgitation and clinical status were assessed in 62 patients with ccTGA. At first visit, systemic AV valve regurgitation ≥ 3/4, systemic RV dysfunction ≥ moderate, and CHF were present in 26%, 26%, and 15% of patients, respectively. None out of 39 Patients with significant POTO had ≥ 3/4 systemic AV valve regurgitation as opposed to 16 (42%) out of 38 patients without significant POTO. During a mean follow-up of 10.1 ± 6.1 years, 40% of patients experienced clinical events (heart failure, transplantation or death). In multivariablee analysis, both systemic ventricular dysfunction (HR: 1.89; 95% CI: 1.05–3.37;P = 0.033) and AV valve regurgitation (HR: 1.99; 95% CI: 1.01–3.92; P = 0.048) were associated with the occurrence of adverse clinical events. Patients with significant POTO were less likely to develop significant systemic AV valve regurgitation (HR: 0.18; 95% CI: 0.05–0.58; P = 0.004) during follow-up. These findings illustrate the importance ventricular-ventricular interaction in patients with a systemic RV as septal shifts influence the systemic AV valve complex. The results of this study suggest pulmonary artery banding can be useful as palliative procedure or to perform LV retraining for possible late arterial switch operation.