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Left ventricular function and exercise capacity after arterial switch operation for transposition of the great arteries: a systematic review and meta-analysis

Published online by Cambridge University Press:  31 May 2018

Sebastiaan W. van Wijk ,
Mieke M. Driessen ,
Folkert J. Meijboom ,
Pieter A. Doevendans ,
Paul H. Schoof ,
Hans M. Breur  and
Tim Takken
Sebastiaan W. van Wijk*
Affiliation:
Department of Paediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, The Netherlands
Mieke M. Driessen
Affiliation:
Department of Cardiology, University Medical Centre Utrecht, The Netherlands
Folkert J. Meijboom
Affiliation:
Department of Paediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, The Netherlands Department of Cardiology, University Medical Centre Utrecht, The Netherlands
Pieter A. Doevendans
Affiliation:
Department of Cardiology, University Medical Centre Utrecht, The Netherlands ICIN-Netherlands Heart Institute, Utrecht, The Netherlands
Paul H. Schoof
Affiliation:
Paediatric Cardiothoracic Surgery, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, The Netherlands
Hans M. Breur
Affiliation:
Department of Paediatric Cardiology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, The Netherlands
Tim Takken
Affiliation:
Paediatric Clinical Exercise Physiology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, The Netherlands
*
Author for correspondence: S. W. van Wijk, Wilhelmina Children’s Hospital, Lundlaan 6, 3584 EA, Utrecht, The Netherlands. Tel: 088 755 5555; Fax: 088 755 5323; E-mail: W.H.S.vanWijk@umcutrecht.nl
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Abstract

Background

The arterial switch operation for transposition of the great arteries was initially believed to be an anatomical correction. Recent evidence shows reduced exercise capacity and left ventricular function in varying degrees in the long term after an arterial switch operation.

Objective

To perform a meta-analysis on long-term exercise capacity and left ventricular ejection fraction after an arterial switch operation.

Methods

A literature search was performed to cover all studies on patients who had undergone a minimum of 6 years of follow-up that reported either left ventricular ejection fraction, peak oxygen uptake, peak workload, and/or peak heart rate. A meta-analysis was performed if more than three studies reported the outcome of interest.

Results

A total of 21 studies reported on the outcomes of interest. Oxygen uptake was consistently lower in patients who had undergone an arterial switch operation compared with healthy controls, with a pooled average peak oxygen uptake of 87.5±2.9% of predicted. The peak heart rate was also lower compared with that of controls, at 92±2% of predicted. Peak workload was significantly reduced in two studies. Pooled left ventricular ejection fraction was normal at 60.7±7.2%.

Conclusion

Exercise capacity is reduced and left ventricular ejection fraction is preserved in the long term after an arterial switch operation for transposition of the great arteries.

Keywords

LVEFexercise capacityTGAtransposition of the great arteries
Type
Review Articles
Information
Cardiology in the Young , Volume 28 , Issue 7 , July 2018 , pp. 895 - 902
Copyright
© Cambridge University Press 2018 

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