Korean Circ J.  2021 Jan;51(1):83-93. 10.4070/kcj.2020.0249.

Growth Pattern of the Neo-Aorta after Arterial Switch Operation during Childhood

• Cha SG
• Baek JS
• Yu JJ
• Kim YH
• Kwon BS
• Choi ES
• Park CS
• Yun TJ

• KMID: 2509908
• DOI: http://doi.org/10.4070/kcj.2020.0249

Abstract

Background and Objectives
Neo-aortic root dilatation (ARD) and annular dilatation (AAD) tend to develop after arterial switch operation (ASO). However, the trend of neo-aortic growth has not been well established. This paper aims to identify this trend, its associated factors, and predictors of neo-aortic dilatation after ASO.
Methods
We analyzed the growth trend of the neo-aortic root, annulus, and sinotubular junction (STJ) z-scores using random coefficients model and the risk factors affecting neoaortic dilatation in 163 patients who underwent ASO from 2006 to 2015.
Results
Among 163 patients, 41 had a ventricular septal defect, and 11 had Taussig-Bing (TB) anomaly. The median follow-up duration was 6.61 years. The increased in the neo-aortic root z-score was different between the trapdoor and non-trapdoor coronary artery transfer techniques (0.149/year, p<0.001 vs. 0.311/year, p<0.001). Moreover, the neo-aortic annulus and STJ z-score significantly increased over time after ASO (0.067/year, p<0.001; 0.309/ year, p<0.001). Pulmonary artery banding (PAB) was rather a negative affecting factor. The probabilities of freedom from ARD, AAD, and neo-aortic STJ dilatation at 10 years after ASO were 33.4%, 53.9%, and 65.4%. Neo- aortic regurgitation within 1 year was the predictor of ARD, AAD, and neo-aortic STJ dilatation. TB anomaly, PAB, and native pulmonary sinus z-score were other predictors for ARD.
Conclusion
The growth of neo-aortic root, annulus, and STJ after ASO was greater than somatic growth during childhood. The coronary artery transfer technique affected the growth pattern of the neo-aortic root.

Keyword

Aorta; Dilatation; Arterial switch operation

Figure

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  Figure 1 Post-ASO change of neo-aorta z-scores and STJ/annulus ratio in TGA using multivariate random coefficients model.Neo-aortic root z-scores increased over time after ASO at a rate of 0.149/year in the trapdoor group and 0.311/year in the non-trapdoor group (A). Neo-aortic annulus and STJ z-scores increased over time at a rate of 0.067/year (B) and 0.309/year (C) respectively. The STJ/annulus ratio also increased over time after ASO (0.021/year) (D). The interaction between PAB prior to ASO and time was excluded in multivariate random coefficients model for neo-aortic root and annulus z-scores because the number of patients in the PAB group was significantly small (n=4).ASO = arterial switch operation; PAB = pulmonary artery banding; STJ = sinotubular junction; TGA = transposition of the great arteries.

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  Figure 2 Kaplan-Meier graph for probabilities of freedom from ARD, AAD, and neo-aortic STJ dilatation.The probabilities of freedom from ARD (dotted line) at 1, 5, and 10 years after operation were 69.3%, 46.0%, and 33.4% and the probabilities of freedom from AAD (line) and neo-aortic STJ dilatation (large dotted line) at 1, 5, and 10 years after operation were 76.7%, 60.3%, and 53.9% and 94.5%, 78.1%, and 65.4%, respectively. The probabilities of freedom from neo-aortic structure dilatation are significantly different.AAD = neo-aortic annulus dilatation; ARD = neo-aortic root dilatation; ASO = arterial switch operation; post-Op = postoperative; STJ = sinotubular junction.

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