Growth of the Neo-Aortic Root and Prognosis of Transposition of the Great Arteries.
Aorta
Congenital
Conotruncal
Root
Valve
Journal
Journal of the American College of Cardiology
ISSN: 1558-3597
Titre abrégé: J Am Coll Cardiol
Pays: United States
ID NLM: 8301365
Informations de publication
Date de publication:
31 Oct 2023
31 Oct 2023
Historique:
received:
02
10
2023
revised:
23
10
2023
accepted:
24
10
2023
medline:
9
11
2023
pubmed:
9
11
2023
entrez:
8
11
2023
Statut:
aheadofprint
Résumé
Neo-aortic root dilatation can lead to significant late morbidity after the arterial switch operation (ASO) for dextro-transposition of the great arteries (d-TGA). We sought to examine the growth of the neo-aortic root in d-TGA. A single-center, retrospective cohort study of patients that underwent the ASO from 07/1981-09/2022 was performed. Morphology was categorized as d-TGA with intact ventricular septum (d-TGA-IVS), d-TGA with ventricular septal defect (d-TGA-VSD), and double-outlet right ventricle-TGA type (DORV-TGA). Echocardiographically-determined diameters and derived z-scores were measured at the annulus, sinus of Valsalva (SoV), and sinotubular junction (STJ) immediately before the ASO and throughout follow-up. Trends in root dimensions over time were assessed using linear mixed-effects models. The association between intrinsic morphology and the composite of moderate-severe aortic regurgitation (AR) and neo-aortic valve or root reintervention was evaluated with uni- and multivariable Cox proportional hazards models. Of 1359 patients that underwent the ASO, 593 (44%), 666 (49%), and 100 (7%) patients had d-TGA-IVS, d-TGA-VSD, and DORV-TGA, respectively. Each patient underwent a median of 5 (IQR 3-10) echocardiograms over a median follow-up of 8.6 years (range 0.1-39.3 years). At 30 years, DORV-TGA patients demonstrated greater annular (p<0.001), SoV (p=0.039), and STJ (p=0.041) dilatation relative to d-TGA-IVS patients. On multivariable analysis, intrinsic anatomy, older age at ASO, at least mild AR at baseline, and high-risk root dilatation were associated with moderate-severe AR and neo-aortic valve or root reintervention at late follow-up (all p<0.05). Longitudinal surveillance of the neo-aortic root is warranted long after the ASO.
Sections du résumé
BACKGROUND
BACKGROUND
Neo-aortic root dilatation can lead to significant late morbidity after the arterial switch operation (ASO) for dextro-transposition of the great arteries (d-TGA).
OBJECTIVES
OBJECTIVE
We sought to examine the growth of the neo-aortic root in d-TGA.
METHODS
METHODS
A single-center, retrospective cohort study of patients that underwent the ASO from 07/1981-09/2022 was performed. Morphology was categorized as d-TGA with intact ventricular septum (d-TGA-IVS), d-TGA with ventricular septal defect (d-TGA-VSD), and double-outlet right ventricle-TGA type (DORV-TGA). Echocardiographically-determined diameters and derived z-scores were measured at the annulus, sinus of Valsalva (SoV), and sinotubular junction (STJ) immediately before the ASO and throughout follow-up. Trends in root dimensions over time were assessed using linear mixed-effects models. The association between intrinsic morphology and the composite of moderate-severe aortic regurgitation (AR) and neo-aortic valve or root reintervention was evaluated with uni- and multivariable Cox proportional hazards models.
RESULTS
RESULTS
Of 1359 patients that underwent the ASO, 593 (44%), 666 (49%), and 100 (7%) patients had d-TGA-IVS, d-TGA-VSD, and DORV-TGA, respectively. Each patient underwent a median of 5 (IQR 3-10) echocardiograms over a median follow-up of 8.6 years (range 0.1-39.3 years). At 30 years, DORV-TGA patients demonstrated greater annular (p<0.001), SoV (p=0.039), and STJ (p=0.041) dilatation relative to d-TGA-IVS patients. On multivariable analysis, intrinsic anatomy, older age at ASO, at least mild AR at baseline, and high-risk root dilatation were associated with moderate-severe AR and neo-aortic valve or root reintervention at late follow-up (all p<0.05).
CONCLUSIONS
CONCLUSIONS
Longitudinal surveillance of the neo-aortic root is warranted long after the ASO.
Identifiants
pubmed: 37939977
pii: S0735-1097(23)07874-9
doi: 10.1016/j.jacc.2023.10.023
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023. Published by Elsevier Inc.