升主动脉根部的生长与大动脉转位的预后。
Growth of the Neo-Aortic Root and Prognosis of Transposition of the Great Arteries.
机构信息
Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA.
The Cardiac Registry, Departments of Cardiology, Pathology, and Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts, USA; Department of Pathology, Harvard Medical School, Boston, Massachusetts, USA.
出版信息
J Am Coll Cardiol. 2024 Jan 30;83(4):516-527. doi: 10.1016/j.jacc.2023.10.023. Epub 2023 Nov 6.
BACKGROUND
Neo-aortic root dilatation can lead to significant late morbidity after the arterial switch operation (ASO) for dextro-transposition of the great arteries (d-TGA).
OBJECTIVES
We sought to examine the growth of the neo-aortic root in d-TGA.
METHODS
A single-center, retrospective cohort study of patients who underwent the ASO between July 1, 1981 and September 30, 2022 was performed. Morphology was categorized as dextro-transposition of the great arteries with intact ventricular septum (d-TGA-IVS), dextro-transposition of the great arteries with ventricular septal defect (d-TGA-VSD), and double-outlet right ventricle-transposition of the great arteries type (DORV-TGA). Echocardiographically determined diameters and derived z scores were measured at the annulus, sinus of Valsalva, and sinotubular junction immediately before the ASO and throughout follow-up. Trends in root dimensions over time were assessed using linear mixed-effects models. The association between intrinsic morphology and the composite of moderate-severe aortic regurgitation (AR) and neo-aortic valve or root intervention was evaluated with univariable and multivariable Cox proportional hazards models.
RESULTS
Of 1,359 patients who underwent the ASO, 593 (44%), 666 (49%), and 100 (7%) patients had d-TGA-IVS, d-TGA-VSD, and DORV-TGA, respectively. Each patient underwent a median of 5 echocardiograms (Q1-Q3: 3-10 echocardiograms) over a median follow-up of 8.6 years (range: 0.1-39.3 years). At 30 years, patients with DORV-TGA demonstrated greater annular (P < 0.001), sinus of Valsalva (P = 0.039), and sinotubular junction (P = 0.041) dilatation relative to patients with d-TGA-IVS. On multivariable analysis, intrinsic anatomy, older age at ASO, at least mild AR at baseline, and high-risk root dilatation were associated with moderate-severe AR and neo-aortic valve or root intervention at late follow-up (all P < 0.05).
CONCLUSIONS
Longitudinal surveillance of the neo-aortic root is warranted long after the ASO.
背景
左心室大动脉错位（d-TGA）患者行大动脉调转术（ASO）后，新发主动脉根部扩张可导致严重的晚期发病率。
目的
本研究旨在探讨 d-TGA 患者的新发主动脉根部生长情况。
方法
这是一项单中心、回顾性队列研究，纳入 1981 年 7 月 1 日至 2022 年 9 月 30 日期间行 ASO 的患者。形态学分类为：完整室间隔的大动脉错位（d-TGA-IVS）、室间隔缺损的大动脉错位（d-TGA-VSD）和右心室双出口-大动脉错位型（DORV-TGA）。ASO 前和随访期间，通过超声心动图测量主动脉瓣环、主动脉窦和窦管交界的直径，并计算直径的 z 评分。采用线性混合效应模型评估根部尺寸随时间的变化趋势。使用单变量和多变量 Cox 比例风险模型评估固有形态与中重度主动脉瓣反流（AR）和新发主动脉瓣或根部干预的复合终点之间的关系。
结果
在 1359 例行 ASO 的患者中，593 例（44%）、666 例（49%）和 100 例（7%）患者分别患有 d-TGA-IVS、d-TGA-VSD 和 DORV-TGA。每位患者的中位随访时间为 8.6 年（范围：0.1-39.3 年），中位数接受了 5 次超声心动图检查（Q1-Q3：3-10 次）。30 年时，与 d-TGA-IVS 患者相比，DORV-TGA 患者的瓣环（P<0.001）、主动脉窦（P=0.039）和窦管交界（P=0.041）扩张更为明显。多变量分析显示，固有解剖结构、ASO 时年龄较大、基线时至少存在轻度 AR 以及高危根部扩张与晚期随访时的中重度 AR 和新发主动脉瓣或根部干预相关（均 P<0.05）。
结论
ASO 后很长一段时间都需要对新发主动脉根部进行纵向监测。
Zotero 插件