Technique of Coronary Button Transfer Has no Impact on Neoaortic Root Size in Simple Transposition

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Arterial switch operation (ASO) is a common surgical repair for simple transposition of the great arteries.
• Neo-aortic root dilation is a known complication following ASO.
• Coronary transfer techniques (CTT) vary, but their impact on neo-aortic root growth is not well-defined.

Purpose of the Study:

• To evaluate the effect of different coronary transfer techniques (CTT) on neo-aortic root dimensions after ASO in simple transposition.
• To identify predictors of neo-aortic root growth, excluding known predisposing factors.

Main Methods:

• Retrospective review of 178 patients with simple transposition undergoing ASO (2004-2018).
• Patients were grouped by CTT: Punch Hole (n=83), Nonpunch Hole (n=65), and Mixed (n=30).
• Uni/multivariable linear regression analyzed factors predicting neo-aortic annulus, mid-sinus, and sinotubular junction (STJ) z-scores.

Main Results:

• Significant enlargement of the neo-aortic root (annulus, mid-sinus, STJ) was observed post-ASO (P < 0.001).
• Preoperative pulmonary annulus z-score predicted final neo-aortic annulus and STJ z-scores (P=0.03 and P<0.0001, respectively).
• CTT did not significantly predict any neo-aortic root z-scores (P > 0.05); neo-aortic regurgitation was similar across groups.

Conclusions:

• The neo-aortic root undergoes significant enlargement over time after ASO in simple transposition.
• The specific coronary transfer technique employed does not appear to influence this long-term neo-aortic root growth.
• Preoperative pulmonary annulus size is a predictor of neo-aortic root dimensions post-ASO.