Quality of Life of Children After Repair of Transposition of the Great Arteries

Abstract

Background— We sought to assess quality of life of children with transposition of the great arteries (TGA) enrolled during transition in management strategy from atrial to arterial switch operation. Methods and Results— Neonates enrolled by the Congenital Heart Surgeons Society in a prospective study of TGA between 1985 and 1989 were eligible. A Child Health Questionnaire was sent for completion by the child between February and June 2000. Data were compared with published normative values. Child Health Questionnaires were completed by 306 of 708 survivors at a mean age of 13±1 years. Diagnosis included TGA (n=202, 66%), TGA/ventricular septal defect (VSD) (n=84, 27%), and TGA/VSD/pulmonary stenosis (n=20, 7%). Repair type was arterial switch (n=189, 62%), atrial switch (n=105, 34%; Senning=58, Mustard=47), or Rastelli (n=12, 4%). Children with TGA scored significantly higher than published norms in all categories except self-esteem. TGA/VSD/pulmonary stenosis was associated with lower scores than TGA and TGA/VSD in physical functioning ( P =0.002), general health perceptions ( P =0.012), and mental health ( P =0.048). Arterial repair was associated with higher scores than atrial or Rastelli repair in physical functioning ( P <0.001), pain ( P =0.004), mental health ( P =0.019), self-esteem ( P =0.004), and general health perceptions ( P <0.001). By multivariable analyses, the most common independent factors impacting scores were repair type, perfusion parameters, and gender. Conclusions— Quality of life and health status as perceived by children 11 to 15 years after TGA repair is excellent when compared with published normative data and is better after arterial switch operation than after atrial repair.

The development of the pediatric cardiac quality of life inventory: a quality of life measure for children and adolescents with heart disease

“…These patients have been shown to have lower scores on the Child Health Questionnaire relative to normal children in prior studies [45,46]. Although most forms of biventricular repair result in a more normal cardiovascular physiology, patients with more severe forms of two-ventricle CHD have lower QOL scores on the Child Health Questionnaire compared with those with less severe forms of CHD [47]. To our knowledge this is the first diseasespecific pediatric cardiac instrument to be able to discriminate QOL scores between single-ventricle and biventricular congenital heart lesions in both patient and parent groups.…”

Best Practices in Managing Transition to Adulthood for Adolescents With Congenital Heart Disease: The Transition Process and Medical and Psychosocial Issues

“…In addition, a more positive outcome was found for subjects who had the arterial switch procedure versus the atrial (Senning/ Mustard) repair. 52 Although patients undergoing atrial switch may have had longer periods of cyanosis, they were born during the same time period as the arterial switch patients (1985)(1986)(1987)(1988)(1989).…”

ACC/AHA 2008 Guidelines for the Management of Adults With Congenital Heart Disease

“…565 In the current era, the preference is for an ASO, and the earliest survivors of this procedure are now adolescents and young adults. 566,567 Longterm concerns after the ASO include coronary insufficiency, myocardial ischemia, ventricular dysfunction and arrhythmias, and issues regarding stenosis at the great arterial anastomotic sites, as well as development of aortic or pulmonary regurgitation.…”