The relationship between blood pressure, pulse pressure and right ventricular function following an atrial switch procedure for complete transposition of the great arteries

Background: The pressure overload may be responsible for the failure of the systemic ventricle. No study so far has evaluated the association between arterial blood pressure values and right ventricular function in adults with atrially corrected complete transposition. Methods: This was a retrospective analysis. The studied population consisted of 60 patients with complete transposition, 11.5±2.7 years after atrial switch procedure, divided into subgroups according to the severity of systemic ventricular dysfunction (right ventricular ejection fraction ≤0.40 vs. >0.40), and the severity of perfusion abnormalities in the radionuclide study (absent or mild vs. moderate-to-severe). Results: All patients had blood pressure values (systolic 109.1±11.7 mm Hg and diastolic 72.3±9.7 mm Hg) within the normal range. Systolic blood pressure values correlated inversely with right ventricular ejection fraction (r=−0.450; p<0.001). Compared to patients with systolic blood pressure below median values, patients with “elevated” blood pressure had lower right ventricular ejection fraction (32.6±6.3 vs. 38.9.±7.2; p≤0.002) and more significant perfusion abnormalities (1.5±1.0 vs. 2.9±1.5; p≤0.001). In a multivariate backward logistic regression model age at surgery and at the time of the study, systolic blood pressure at rest predicted impaired right ventricular ejection fraction (p<0.02). Greater pulse pressure at peak exercise female sex were associated with greater more severe perfusion abnormalities (p<0.01). Conclusions: There is a significant correlation between blood pressure values and indices of right ventricular dysfunction in patients who underwent an atrial switch procedure for complete transposition. Blood pressure values might be considered as a surrogate end point in these patients.