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 neo-aortic 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 tissue-gaining 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.