NYHA class and cardiopulmonary exercise capacity impact self-rated health-related quality of life in young adults after arterial switch operation for transposition of the great arteries

Background: Evaluating the impact of subjective physical activity status and cardiopulmonary exercise capacity on physical and mental health-related quality of life (QOL) in young adults after neonatal arterial switch operation for transposition of the great arteries.Methods: In a prospective reassessment study, 92 young adults (age 22.8 +/- 2.6 y) underwent standardized evaluation of health-related QOL (SF-36), NYHA status and cardiopulmonary exercise performance (CPET).Results: Peak oxygen uptake was 33.1 +/- 7.1 ml/kg/min corresponding to 84.5 +/- 15.5% of predicted, according to the borderline subnormal range. 65% were classified as normal or borderline, 35% as impaired. 88% were NYHA class I and 12% class II, 45% exercised regularly. Despite average or even elevated mean scores for the QOL domains, more patients reported significantly poorer results, indicated by increased percentages below-2 SD for physical (5.6%), social (7.8%) and emotional role functioning (8.8%). Significant correlations existed between physical health domains and objective exercise performance (r = 0.23 to 0.34, p = 0.001 to 0.032) as well as NYHA class (r = 0.33 to 0.46, p < 0.001 to 0.002). Mental health domains were also significantly correlated with NYHA class (r = 0.22 to 0.41, p < 0.001 to 0.04) and peak oxygen uptake.Conclusions: Despite good results on average, young adults with TGA after ASO are at elevated risk for a reduced QOL. Objective exercise capacity and NYHA class are significant indicators for self-perceived physical and mental health. Applications of QOL measurement should be part of routine clinical follow up in this patient group.