Persistent neo-aortic growth during adulthood in patients after an arterial switch operation.
OBJECTIVE
After the arterial switch operation (ASO), disproportional neo-aortic growth during childhood has been reported. Even though it has been suggested neo-aortic dilation will stabilise in adulthood, data are lacking. The aim of this study was to assess the change in neo-aortic dimensions, prevalence of neo-aortic dilation >40 mm and long-term outcome in adults who underwent ASO in childhood.


METHODS
All 116 ASO patients operated in a tertiary referral centre and born before 1995 were included. Of these, 83 (72%) survived to adulthood (>17 years) and six were lost to follow-up. Neo-aortic measurements performed in adulthood were collected from available echocardiographic, cardiovascular magnetic resonance and CT images. The time trend was analysed using a mixed model, adjusted for imaging modality.


RESULTS
Clinical data with at least one measurement of the neo-aortic diameter were available in 77 (93%) adult patients and serial measurements in 65 (78%). At baseline (median age 18.1 years), mean neo-aortic diameter was 36±5 mm. Mean neo-aortic growth was 0.31 mm/year (p<0.001 compared with normal value 0.08 mm/year) and was linear over time. Freedom from neo-aortic dilation beyond a diameter of 40 mm was 23% at 28 years of age. During a mean clinical follow-up in adulthood of 7.2 years (IQR 4.0 to 10.1), 3 (4%) patients underwent neo-aortic replacement. No other neo-aortic complications occurred.


CONCLUSIONS
In early adulthood, neo-aortic growth was on average linear and did not stabilise over time.
Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands The Netherlands Heart Institute, Utrecht, The Netherlands.
Teun
T
van der Bom
Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, The Netherlands Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Roel L F
RL
van der Palen
Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
Berto J
BJ
Bouma
Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
Sophie L
SL
van Veldhuisen
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Hubert W
HW
Vliegen
Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.
Thelma C
TC
Konings
Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands.
Aeilko H
AH
Zwinderman
Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, The Netherlands Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
Nico A
NA
Blom
Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, The Netherlands Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Dave R
DR
Koolbergen
Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, The Netherlands Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Mark G
MG
Hazekamp
Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands The Netherlands Heart Institute, Utrecht, The Netherlands.
Barbara J M
BJ
Mulder
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001011:Aorta / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000254:growth & development / Q000473:pathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D004108:Dilatation, Pathologic; D018618:Echocardiography, Doppler, Color; D005260:Female; D006801:Humans; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000473:pathology*; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014188:Transposition of Great Vessels / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
Aorta, Great Vessels and Trauma; Cardiac Surgery