RT Journal Article
SR Electronic
T1 Progression of aortic root dilatation and aortic valve regurgitation after the arterial switch operation
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1732
OP 1740
DO 10.1136/heartjnl-2019-315157
VO 105
IS 22
A1 van der Palen, Roel L F
A1 van der Bom, Teun
A1 Dekker, Annika
A1 Tsonaka, Roula
A1 van Geloven, Nan
A1 Kuipers, Irene M
A1 Konings, Thelma C
A1 Rammeloo, Lukas A J
A1 Ten Harkel, Arend D J
A1 Jongbloed, Monique R M
A1 Koolbergen, Dave R
A1 Mulder, Barbara J M
A1 Hazekamp, Mark G
A1 Blom, Nico A
YR 2019
UL http://heart.bmj.com/content/105/22/1732.abstract
AB 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±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.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.