Growth of the Neo-Aortic Root and Prognosis of Transposition of the Great Arteries

被引:7
作者
Sengupta, Aditya [1 ,10 ]
Carreon, Chrystalle Katte [2 ,3 ,4 ,5 ]
Gauvreau, Kimberlee [6 ,7 ]
Lee, Ji M.
Sanders, Stephen P. [2 ,3 ,4 ,8 ]
Colan, Steven D. [7 ,8 ]
del Nido, Pedro J. [7 ]
Mayer, John E. [9 ]
Nathan, Meena [9 ]
机构
[1] Boston Childrens Hosp, Dept Cardiac Surg, Boston, MA USA
[2] Boston Childrens Hosp, Cardiac Registry, Dept Cardiol, Boston, MA USA
[3] Boston Childrens Hosp, Dept Pathol, Cardiac Registry, Boston, MA USA
[4] Boston Childrens Hosp, Dept Cardiac Surg, Cardiac Registry, Boston, MA USA
[5] Harvard Med Sch, Dept Pathol, Boston, MA USA
[6] Harvard Sch Publ Hlth, Dept Biostat, Boston, MA USA
[7] Boston Childrens Hosp, Dept Cardiol, Boston, MA USA
[8] Harvard Med Sch, Dept Pediat, Boston, MA USA
[9] Harvard Med Sch, Dept Surg, Boston, MA USA
[10] Boston Childrens Hosp, Dept Cardiac Surg, 300 Longwood Ave, Boston, MA 02115 USA
关键词
aorta; congenital; conotruncal; root; valve; SWITCH OPERATION; RISK-FACTORS; REGURGITATION; DILATATION;
D O I
10.1016/j.jacc.2023.10.023
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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 We sought to examine the growth of the neo-aortic root in d-TGA. METHODS A single -center, retrospective cohort study of patients who underwent the ASO between July 1, 1981 and September 30, 2022 was performed. Morphology was categorized as dextro-transposition of the great arteries with intact ventricular septum (d-TGA-IVS), dextro-transposition of the great arteries with ventricular septal defect (d-TGAVSD), and double-outlet right ventricle-transposition of the great arteries type (DORV-TGA). Echocardiographically determined diameters and derived z scores were measured at the annulus, sinus of Valsalva, and sinotubular junction 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 intervention was evaluated with univariable and multivariable Cox proportional hazards models. RESULTS Of 1,359 patients who 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 echocardiograms (Q1 -Q3: 3-10 echocardiograms) over a median follow-up of 8.6 years (range: 0.1-39.3 years). At 30 years, patients with DORV-TGA demonstrated greater annular (P < 0.001), sinus of Valsalva (P = 0.039), and sinotubular junction (P = 0.041) dilatation relative to patients with d-TGA-IVS. 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 intervention at late follow-up (all P < 0.05). CONCLUSIONS Longitudinal surveillance of the neo-aortic root is warranted long after the ASO. (J Am Coll Cardiol 2024;83:516-527) (c) 2024 by the American College of Cardiology Foundation.
引用
收藏
页码:516 / 527
页数:12
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