OBJECTIVE

To describe the growth of neo-aortic root and evolution of regurgitation throughout 10-year follow-up after arterial switch operation (ASO) in patients with transposition of the great arteries.

MATERIAL AND METHODS

Neo-aortic dimensions (annulus/root/sinotubular junction/ascending aorta) and neo-aortic valve regurgitation were assessed using transthoracic 2D echocardiography in 157 patients who underwent ASO between 2008 and 2019 in our hospital. 29.3% of patients had ventricular septal defect (VSD), 8.2% — bicuspid pulmonary valve, 3.2% — left ventricular outflow tract obstruction (LVOTO) and 1.9% — coarctation of the aorta (CoAo). 18.5% of patients underwent two-stage ASO. All patients with TGA were examined after surgery in our hospital at least once a year. The median of the follow-up period was 4.4 (0.2—10.9) years.

RESULTS

Mean Z-scores of neo-aortic annulus, root, sinotubular junction and ascending aorta were 2.82±1.27, 3.51±1.19, 1.67±1.29 and 1.3±1.61, respectively. Concomitant VSD, bicuspid pulmonary valve, LVOTO, CoAo, as well as coronary anatomy and two-stage surgery did not affect neo-aortic annulus, sinotubular junction and ascending aorta dimensions throughout 10-year follow-up. Neo-aortic root dilatation correlated with two-stage ASO (p=0.03) and preoperative LVOTO (p=0.05). Freedom from neo-aortic regurgitation was 81.6%, 16.5% of patients had mild regurgitation, 1.9% — mild-to-moderate regurgitation. Ttwo-stage ASO was a risk factor of mild neo-aortic regurgitation (p=0.0043), bicuspid neo-aortic valve was associated with mild-to-moderate regurgitation (p=0.005).

CONCLUSION

In our patients with TGA, we observed moderate dilatation of neo-aortic annulus and neo-aortic root after ASO. Neo-aortic root dilatation was associated with two-stage ASO and preoperative LVOTO. Ten-year freedom from mild-to-moderate neo-aortic regurgitation was 98.1%. Bicuspid neo-aortic valve was a risk factor of mild-to-moderate regurgitation.