Cardiopulmonary Exercise Testing and Quality of Life Reevaluation in Adults after Arterial Switch Operation for d-transposition of the Great Arteries—A Longitudinal Comparison at Intervals of 9 Years

Background: As part of our follow-up program for d-transposition of the Great Arteries (dTGA) after arterial switch operation (ASO), we reevaluated objective exercise capacity and health-related quality of life (QOL) in adults with increasing age.

Methods: Forty-six patients were reevaluated after a 9-year interval with Cardiopulmonary Exercise Testing (CPET; bicycle) and QOL questionnaire (SF-36) at a mean age of 32 years (Date 2). CPET parameters and QOL scores were compared by the Wilcoxon test with their corresponding results from 9 years ago (Date 1).

Results: CPET: All patients reached maximal exercise effort. Max. power (mean 2.5 vs. 2.2 W/kg, p < 0.001), decreased over time. Peak oxygen uptake (percentage of predicted peak VO₂ according to Wasserman; mean 82.4 ± 14.0 vs. 81.3 ± 13.7%; p = 0.83) was unchanged. The norm percentile according to Dubowy (mean 9.3 ± 13.4 vs. 10.8 ± 11.3; p = 0.09) was unchanged. Ventilatory efficiency at the anaerobic threshold (slope f[VE/VCO₂]; mean 25.7 ± 2.1 vs. 31.3 ± 4.3; p < 0.001), worsened over time. Oxygen pulse (O₂ HR % of predicted; mean 97.1 ± 14.6 vs. 89.0 ± 16.3; p = 0.036) decreased. Breathing equivalent for CO₂ at anaerobic threshold (EQCO₂): mean 25.5 ± 2.3 versus 26.7 ± 2.8 (p = 0.039), increased but stayed normal.

QOL: Physical functioning was better than 9 years ago, each compared with the gender- and age-appropriate 50th standard percentiles. There were no significant differences in the scores for mental health and general health perception over time (see [Table 1]).

Table 1 SF-36 Scores

SF-36 scores:	Time of examination	Patients (m ± SD)	Norm (m ± SD)	p-Value
Physical functioning	Date 1	93.13 ± 16.96	95.81 ± 12.84	0.14
		Date 2	97.00 ± 5.71	93.71 ± 1.17	<0.01
Mental health	Date 1	76.18 ± 15.29	75.30 ± 17.07	0.58
		Date 2	73.83 ± 19.56	73.90 ± 0.93	0.58
General health perception	Date 1	77.69 ± 17.97	77.48 ± 18.31	0.91
		Date 2	77.77 ± 17.72	74.43 ± 1.00	0.153

Conclusion: In the fourth decade after ASO for TGA, a persistent borderline normal functional status according to CPET criteria is present, with no decline after a 9-year interval. A good physical, psychological, and general quality of life is preserved over time.

Publication History

Article published online:
11 February 2025