Progression of aortic root dilatation and aortic valve regurgitation after the arterial switch operation

• Published in: Heart (British Cardiac Society) Vol. 105; no. 22; pp. 1732 - 1740
• Main Authors: van der Palen, Roel L F, van der Bom, Teun, Dekker, Annika, Tsonaka, Roula, van Geloven, Nan, Kuipers, Irene M, Konings, Thelma C, Rammeloo, Lukas A J, Ten Harkel, Arend D J, Jongbloed, Monique R M, Koolbergen, Dave R, Mulder, Barbara J M, Hazekamp, Mark G, Blom, Nico A
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.11.2019; BMJ Publishing Group
• Series: Original research article
• Subjects: Age; Aortic aneurysms; Congenital Heart Disease; Defects; Heart; Morphology; Risk factors; Statistical analysis; Ultrasonic imaging; Veins & arteries; Netherlands; transposition of the great arteries; aortic aneurysm; aortic regurgitation; congenital heart disease surgery; echocardiography
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heartjnl-2019-315157

ObjectiveTo study neo-aortic growth and the evolution of neo-aortic valve regurgitation (AR) in patients with transposition of the great arteries (TGA) after arterial switch operation (ASO) from newborn to adulthood and to identify patients at risk.MethodsNeo-aortic dimensions (annulus/root/sinotubular junction) and neo-aortic valve regurgitation were assessed serially in 345 patients with TGA who underwent ASO between 1977 and 2015. Linear mixed-effect models were used to assess increase of neo-aortic dimensions over time and to identify risk factors for dilatation. Risk factor analysis for AR by using time-dependent Cox regression models.ResultsAfter a rapid increase in the first year after ASO and proportional growth in childhood, neo-aortic dimensions continue to increase in adulthood without stabilisation. Annual diameter increase in adulthood was 0.39±0.06, 0.63±0.09 and 0.54±0.11 mm for, respectively, neo-aortic annulus, root and sinotubular junction, all significantly exceeding normal growth. AR continues to develop over time: freedom from AR ≥moderate during the first 25 years post-ASO was 69%. Risk factors for root dilatation were complex TGA anatomy (TGA-ventricular septal defect (VSD), double outlet right ventricle with subpulmonary VSD) and male gender. Risk factors for AR ≥moderate were: complex TGA anatomy and neo-aortic growth. Per millimetre increase in aortic root dimension, there was a 9% increase in the hazard of AR ≥moderate. Bicuspid pulmonary valve did not relate to the presence of root dilatation or AR.ConclusionAfter ASO, neo-aortic dilatation proceeds beyond childhood and is associated with an increase in AR incidence over time. Careful follow-up of the neo-aortic valve and root function is mandatory, especially in males and in patients with complex TGA anatomy.