@article {van der Palen1732, author = {Roel L F van der Palen and Teun van der Bom and Annika Dekker and Roula Tsonaka and Nan van Geloven and Irene M Kuipers and Thelma C Konings and Lukas A J Rammeloo and Arend D J Ten Harkel and Monique R M Jongbloed and Dave R Koolbergen and Barbara J M Mulder and Mark G Hazekamp and Nico A Blom}, title = {Progression of aortic root dilatation and aortic valve regurgitation after the arterial switch operation}, volume = {105}, number = {22}, pages = {1732--1740}, year = {2019}, doi = {10.1136/heartjnl-2019-315157}, publisher = {BMJ Publishing Group Ltd}, abstract = {Objective To 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.Methods Neo-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.Results After 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{\textpm}0.06, 0.63{\textpm}0.09 and 0.54{\textpm}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.Conclusion After 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.}, issn = {1355-6037}, URL = {https://heart.bmj.com/content/105/22/1732}, eprint = {https://heart.bmj.com/content/105/22/1732.full.pdf}, journal = {Heart} }