Neo-aortic root dilatation of left ventricular outflow tract obstruction after arterial switch operation
Presented During:
Saturday, May 3, 2025: 5:30PM - 5:45PM
Seattle Convention Center | Summit
Posted Room Name:
Ballroom 2, Level 5
Abstract No:
117
Submission Type:
Abstract Submission
Authors:
Yasuyuki Kobayashi (1), Rebecca Beroukhim (1), Sitaram Emani (1)
Institutions:
(1) Boston Children's Hospital, Boston, MA
Submitting Author:
Yasuyuki Kobayashi
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Boston Children's Hospital
Boston Children's Hospital
Co-Author(s):
Rebecca Beroukhim
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Boston Children's Hospital
Boston Children's Hospital
*Sitaram Emani
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Boston Children's Hospital
Boston Children's Hospital
Presenting Author:
Yasuyuki Kobayashi
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Boston Children's Hospital
Boston Children's Hospital
Abstract:
Objective: Patients with either d- transposition of great arteries (TGA) or L-TGA and native left ventricular outflow obstruction (LVOTO) are at risk for aortic insufficiency (AI) following arterial switch operation (ASO) and LVOT resection due to thin pulmonary artery (neoaortic) wall. We hypothesize that patients with native LVOTO are more likely to develop neo-AI following ASO compared to those with antecedent pulmonary artery banding (PAB).
Methods: A single-institution, retrospective review was performed on 152 patients who underwent arterial switch operation (ASO) with native LVOTO (N=48) or following previous PAB (N=104) between 2010 and 2024. Freedom from reintervention for neo-AI was estimated with the Kaplan-Meier method.
Results: The median age at ASO was 1.4 (0.7–3.0) years in the LVOTO group and 2.0 (1.1–4.3) years in the PAB group, respectively. Simultaneous neo-aortic root reduction at the time of ASO was performed on 13 patients (27%) in the LVOTO group and 35 patients (34%) in the PAB group. Root reduction was performed on patients with larger neo-aortic root Z score (root Z) before ASO (mean root Z; root reduction +, 2.86 vs. root reduction -, -1.03, P <0.001). AI-related reoperation was required in 11 patients (23%) in the LVOTO group and 4 patients (4%) in the PAB group. Freedom from AI-related reoperation at 5 years was higher in the PAB group (PAB group, 92.8 [77.3-97.9]%; LVOTO group, 57.0 [¬31.3–76.2]%; P<0.001). All of the 11 patients who required AI-related reoperation in the LVOTO group demonstrated root Z ≥ -1 before ASO and central AI at the time of reoperation. In these patients, root Z became larger rapidly during admission (mean root Z; post-bypass, -1.16 vs. at discharge, 0.40, P=0.003). In the LVOTO group, when stratified by the combination of root reduction and root Z of -1 before ASO, freedom from AI-related reoperation was 100% in the patients with root Z <-1 (all did not undergo root reduction), 73.3 (24.3–93.4)% in the patients with root Z ≥-1 and root reduction, and 29.8 (6.2–59.0)% in the patients with root Z ≥-1 and without root reduction (P=0.015).
Conclusions: Neo-aortic root expansion occurred quickly, and AI-related reoperation was frequent among the patients with TGA and LVOTO. Simultaneous root reduction may help reduce the reoperation, but further surgical strategy, including LVOTO release plus PAB or root translocation, should be considered for TGA/LVOTO patients.
Methods: A single-institution, retrospective review was performed on 152 patients who underwent arterial switch operation (ASO) with native LVOTO (N=48) or following previous PAB (N=104) between 2010 and 2024. Freedom from reintervention for neo-AI was estimated with the Kaplan-Meier method.
Results: The median age at ASO was 1.4 (0.7–3.0) years in the LVOTO group and 2.0 (1.1–4.3) years in the PAB group, respectively. Simultaneous neo-aortic root reduction at the time of ASO was performed on 13 patients (27%) in the LVOTO group and 35 patients (34%) in the PAB group. Root reduction was performed on patients with larger neo-aortic root Z score (root Z) before ASO (mean root Z; root reduction +, 2.86 vs. root reduction -, -1.03, P <0.001). AI-related reoperation was required in 11 patients (23%) in the LVOTO group and 4 patients (4%) in the PAB group. Freedom from AI-related reoperation at 5 years was higher in the PAB group (PAB group, 92.8 [77.3-97.9]%; LVOTO group, 57.0 [¬31.3–76.2]%; P<0.001). All of the 11 patients who required AI-related reoperation in the LVOTO group demonstrated root Z ≥ -1 before ASO and central AI at the time of reoperation. In these patients, root Z became larger rapidly during admission (mean root Z; post-bypass, -1.16 vs. at discharge, 0.40, P=0.003). In the LVOTO group, when stratified by the combination of root reduction and root Z of -1 before ASO, freedom from AI-related reoperation was 100% in the patients with root Z <-1 (all did not undergo root reduction), 73.3 (24.3–93.4)% in the patients with root Z ≥-1 and root reduction, and 29.8 (6.2–59.0)% in the patients with root Z ≥-1 and without root reduction (P=0.015).
Conclusions: Neo-aortic root expansion occurred quickly, and AI-related reoperation was frequent among the patients with TGA and LVOTO. Simultaneous root reduction may help reduce the reoperation, but further surgical strategy, including LVOTO release plus PAB or root translocation, should be considered for TGA/LVOTO patients.
CONGENTIAL:
Left ventricular outflow tract obstruction
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