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Aortic coarctation and long-term morbidity after arterial switch operation: a multicentre international cohort study

Francisco Javier Ruperti-Repilado1,2,3, Raquel Ladrón4, Pedro Lopez-Ayala2

  • 1Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland javier.ruperti@usb.ch.

Heart (British Cardiac Society)
|July 23, 2025
PubMed

Insights

Aortic coarctation, not VSD, is the main cause of long-term heart problems after arterial switch operation (ASO). Patients need specific surgical care and lifelong monitoring for better outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Congenital Heart Disease Research

Background:

  • Dextro-transposition of the great arteries (dTGA) patients often face complications post-arterial switch operation (ASO).
  • Complex anatomy, particularly ventricular septal defects (VSDs), is associated with adverse outcomes.
  • The independent impact of aortic coarctation (CoA) on long-term morbidity after ASO is not well-defined.

Purpose of the Study:

  • To determine the independent role of aortic coarctation (CoA) versus ventricular septal defects (VSDs) in predicting long-term outcomes after arterial switch operation (ASO) in adults.
  • To identify anatomical factors driving cardiovascular complications and interventions post-ASO.

Main Methods:

  • Analysis of 502 adult patients from the EPOCH-ASO multicentre registry.
  • Primary outcome: time to first right ventricular outflow tract (RVOT)-related intervention.
  • Secondary outcomes: left ventricular outflow tract (LVOT)-related interventions and cardiovascular complications.
  • Statistical analysis using adjusted Cox regression and Andersen-Gill models.

Main Results:

  • Aortic coarctation (CoA) was the strongest independent predictor for RVOT interventions (HR 2.62), LVOT interventions (HR 10.75), and cardiovascular complications (HR 2.16).
  • Ventricular septal defects (VSDs) showed weaker or no significant association with these outcomes.
  • CoA also predicted increased recurrence rates for both RVOT and LVOT interventions.

Conclusions:

  • Aortic coarctation (CoA), rather than VSD, is the primary anatomical factor contributing to long-term morbidity in adults following ASO.
  • Patients with CoA post-ASO require specialized surgical management and continuous, lifelong follow-up to minimize future cardiovascular events.
Abstract

Keywords:
Aortic CoarctationTransposition of Great Vessels

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