Reoperation for neoaortic root pathology after the arterial switch operation

Koolbergen, David R.; Manshanden, J.S.J.; Yazdanbakhsh, Aria P.; Bouma, Berto J.; Blom, Nico A.; Mol, Bas A.J.M. de; Mulder, Barbara J.M.; Hazekamp, Mark G.

doi:10.1093/ejcts/ezu026

Cited by 45 publications

(50 citation statements)

References 22 publications

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“…While there are no reports suggesting increased risk of neo-aortic dissection or rupture at diameters <55 mm, data to establish specific surgical thresholds for post-ASO patients are lacking (table 3). Neo-aortic root operations are safe, despite technical challenges imposed by complex anatomy,97 but are uncommon up to 15 years after ASO 57 58…”

Section: Managementmentioning

confidence: 99%

Aortopathies in adult congenital heart disease and genetic aortopathy syndromes: management strategies and indications for surgery

Kuijpers

Mulder

2017

Heart

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Section: Managementmentioning

confidence: 99%

Aortopathies in adult congenital heart disease and genetic aortopathy syndromes: management strategies and indications for surgery

Kuijpers

Mulder

2017

Heart

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“…The presence of aortic root dilatation has been demonstrated in up to 60% to 70% of patients after ASO; nonetheless, it does not tend to be progressive during late follow-up. Conversely, the progression of the degree of neoaortic valve insufficiency rarely occurs during the first 10 to 15 years after ASO, but it was found that it increases significantly later, and this is associated with the degree of postoperative neoaortic valve insufficiency at discharge soon after ASO [14,20,21]. Anatomic causes identified to be responsible for aortic root dilatation and neoaortic valve insufficiency included the presence of a ventricular septal defect and aortic/pulmonary mismatch and the postoperative geometry of the aortic root [19].…”

Section: Commentmentioning

confidence: 99%

Left-Sided Reoperations After Arterial Switch Operation: A European Multicenter Study

Vida

Zanotto

et al. 2017

The Annals of Thoracic Surgery

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“…The flow displacement direction from root to mid‐AAo also corresponded to the peak systolic WSS distribution in the mid‐AAo, but the contribution of FD on WSS distribution more upstream in the distal AAo was less compared with the effect of vessel tapering. The regions of abnormal increased WSS in the distal AAo clinically correlates with the location of the paper‐thin and fragile anterior wall of the AAo that has been found in ASO patients during root reoperations …”

Section: Discussionmentioning

confidence: 69%

Altered Ascending Aorta Hemodynamics in Patients After Arterial Switch Operation for Transposition of the Great Arteries

Palen

Deurvorst

Kroft

et al. 2019

Magnetic Resonance Imaging

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Background Patients with transposition of the great arteries (TGA) have an altered aortic geometry after an arterial switch operation (ASO), with neo‐aortic root dilatation as an important complication. Geometry‐related aortic hemodynamics have been assumed to contribute to pathology of the ascending aorta (AAo). Purpose To evaluate aortic flow displacement (FD) and regional wall shear stress (WSS) in relation to ascending neo‐aortic geometry in children after ASO. Study Type Prospective. Population Twenty‐eight TGA patients after ASO and 10 healthy volunteers. Field Strength/Sequence 3.0T/4D flow (segmented fast‐spoiled echo pulse), noncontrast‐enhanced MR angiography (Dixon), and anatomic images (SSFP). Assessment Aortic diameters and body surface area‐indexed aortic dimensions (Z‐scores), normalized FD and planar ascending aortic WSS. Statistical Tests Mann–Whitney and chi‐square tests for differences in FD magnitude, WSS, and FD directionality between groups, respectively. Spearman rank correlation to assess the degree of association between aortic geometry, FD and WSS parameters. Shapiro–Wilk test to evaluate distribution normality on the absolute differences in octant location between FD and WSS. Results TGA patients showed a significantly dilated proximal AAo and relatively small mid‐AAo dimensions at the level of the pulmonary arteries (Z‐scores neo‐aortic root: 4.38 ± 1.96 vs. 1.52 ± 0.70, P < 0.001; sinotubular junction: 3.48 ± 2.67 vs. 1.38 ± 1.30, P = 0.010; mid‐AAo: 0.32 ± 3.06 vs. 1.69 ± 1.24, P = 0.001). FD magnitude was higher in TGA patients (neo‐aortic root: 0.048 ± 0.027 vs. 0.021 ± 0.006, P < 0.001; sinotubular junction: 0.054 ± 0.037 vs. 0.029 ± 0.013, P < 0.05) and was related to the neo‐aortic Z‐score. Clear areas of higher WSS at the right and anterior aortic wall regions along the distal AAo were detected in TGA patients, most pronounced in those with relatively smaller mid‐AAo diameters. Data Conclusion TGA‐specific geometry related to the ASO, evidenced by neo‐aortic root dilatation and a sudden change in vessel diameter at mid‐AAo level, leads to more aortic flow asymmetry in the proximal AAo and WSS distribution with higher WSS at the right and anterior aortic wall regions along the distal AAo. Level of Evidence: 1 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2020;51:1105–1116.

show abstract

Reoperation for neoaortic root pathology after the arterial switch operation

Abstract: After ASO, surgery for neoaortic root pathology may become necessary when follow-up is long enough and regardless of primary diagnosis or other risk factors. Redo neoaortic surgery can be performed with low risk taking into account the specific technical difficulties.

Cited by 45 publications

References 22 publications

Aortopathies in adult congenital heart disease and genetic aortopathy syndromes: management strategies and indications for surgery

Aortopathies in adult congenital heart disease and genetic aortopathy syndromes: management strategies and indications for surgery

Left-Sided Reoperations After Arterial Switch Operation: A European Multicenter Study

Altered Ascending Aorta Hemodynamics in Patients After Arterial Switch Operation for Transposition of the Great Arteries

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