Teun van der Bom1, Roel L F van der Palen2, Berto J Bouma3, Sophie L van Veldhuisen3, Hubert W Vliegen4, Thelma C Konings5, Aeilko H Zwinderman6, Nico A Blom2, Dave R Koolbergen7, Mark G Hazekamp7, Barbara J M Mulder1. 1. Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands The Netherlands Heart Institute, Utrecht, The Netherlands. 2. Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, The Netherlands Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands. 3. Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands. 4. Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. 5. Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands. 6. Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands. 7. Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, The Netherlands Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Abstract
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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Entities:
Keywords:
Aorta, Great Vessels and Trauma; Cardiac Surgery
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