117. Neo-aortic root dilatation of left ventricular outflow tract obstruction after arterial switch operation
UCLA Ronald Reagan Medical Center
LOS ANGELES, CA
United States - Contact Me
Professor and Chief of Congenital Heart Surgery, UCLA
Former Head of Cardiovascular Surgery, Hospital for Sick Children, Toronto
Form Professor and Chair the Division of Cardiac Surgery, University of Toronto
Children's Hospital of Philadelphia
Philadelphia, PA
United States - Contact Me
Dr. Kobayashi is a clinical fellow at Boston Children's Hospital and was previously a cardiovascular surgery clinical fellow at Okayama University Hospital in Japan. He obtained a Ph.D. from Okayama University in 2021, focusing on ex vivo heart perfusion for DCD (donation after circulatory determination of death) hearts using large animals.
Dr. Kobayashi's clinical interests include open-heart surgery for neonates and infants with complex congenital heart diseases, valve disease, and surgical palliation for single-ventricle patients. His primary focus is on biventricular repair, particularly for unbalanced atrioventricular septal defect, complex transposition, heterotaxy syndrome, and Fontan takedown.
Description
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.
Authors
Yasuyuki Kobayashi (1), Rebecca Beroukhim (1), Sitaram Emani (1)
Institutions
(1) Boston Children's Hospital, Boston, MA