Long-term impact of coronary artery transfer techniques during the arterial switch operation on neo-aortic root dilation

Background: Aortic dilation (AD) remains one of the most common complications needing re-operation after ASO (arterial switch operation) in simple transposition of the great arteries (TGA). Objectives: We sought to clarify which coronary artery transfer techniques help to minimize postoperative neoaortic root dilation after ASO for TGA. Methods: 117 patients were identified in the German National Register for Congenital Heart Defects presenting transposition of the great arteries with intact ventricular septum (TGA-IVS) with minimum 5-year follow-up who underwent ASO between 1986 and 2015 at 16 centers. Our study population was divided into two groups depending on the sinus tissue gain during coronary re-implantation. Group one (n = 72) included the tissuegaining techniques slit, trap-door, J-/V-/U-incision, and pericardial augmentation. Group two (n = 45) included 'punch' as the no-tissue gaining technique. Transthoracic echocardiography data were analyzed retrospectively for development of neoaortic dilation defined by Z-score >= 2.0. As secondary endpoint was analyzed, the need for reintervention due to aortic pathology. Results: Median follow-up was 11 (5-29) years; cumulative follow-up was 853 patient-years for group one and 19 (5-34) years; cumulative follow-up was 853 patient-years for group two, comprising 1706 patient-years, p < 0.0001. We observed statistically significant higher Z-scores at the aortic valve annulus level in group one (p = 0.03). There was no statistically significant difference between both groups regarding re-operation. Conclusion: Neo-aortic roots of patients who underwent sinus gain tissue coronary artery transfer techniques show higher Z-scores than the punch technique in long-term postoperative follow-up. Lifelong surveillance of patients after ASO seems necessary.