{
  "abstract": "Background In patients with dextro-transposition of the great arteries, cardiovascular interventions and complications are common after the arterial switch operation (ASO). While complex anatomy—typically defined by ventricular septal defects (VSDs)—is often linked to these outcomes, the independent role of aortic coarctation (CoA) remains unclear.Methods We analysed 502 adults from the EPOCH (European collaboration for Prospective Outcome research in Congenital Heart disease)-ASO multicentre registry (median age 25.5 years). The primary outcome was time to first right ventricular outflow tract (RVOT)-related intervention. Secondary outcomes included left ventricular outflow tract (LVOT)-related interventions and cardiovascular complications. Associations were assessed using adjusted Cox regression and Andersen-Gill models.Results CoA emerged as the strongest independent predictor of RVOT interventions (HR 2.62), LVOT interventions (HR 10.75) and cardiovascular complications (HR 2.16). In contrast, VSD (complex anatomy) showed weaker or no associations. CoA also predicted higher recurrence rates of both RVOT and LVOT interventions.Conclusions Among adults post-ASO, CoA—not VSD—is the dominant anatomical driver of long-term morbidity. These patients require targeted surgical attention and structured, lifelong follow-up to mitigate future complications.Trial registration number NCT04335448.",
  "authors": [
    {
      "affiliations": [
        "Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland",
        "Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland",
        "Adult Congenital Heart Disease Unit, Virgen del Rocio University Hospital Cardiology and Cardiovascular Surgery Service, Sevilla, Spain"
      ],
      "name": "Francisco Javier Ruperti-Repilado"
    },
    {
      "affiliations": [
        "Virgen del Rocio University Hospital, Seville, Spain"
      ],
      "name": "Raquel Ladrón"
    },
    {
      "affiliations": [
        "Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland"
      ],
      "name": "Pedro Lopez-Ayala"
    },
    {
      "affiliations": [
        "Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland"
      ],
      "name": "Beshoy Gabra"
    },
    {
      "affiliations": [
        "Unitat Integrada de Cardiopaties Congènites de l’Adolescent i Adult, Vall d’Hebron University Hospital, Barcelona, Spain"
      ],
      "name": "Victor González-Fernández"
    },
    {
      "affiliations": [
        "Cardiology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands"
      ],
      "name": "Leo J Engele"
    },
    {
      "affiliations": [
        "Virgen del Rocio University Hospital, Seville, Spain"
      ],
      "name": "Begoña Manso"
    },
    {
      "affiliations": [
        "Cardiology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands"
      ],
      "name": "Berto J Bouma"
    },
    {
      "affiliations": [
        "Adult Congenital Heart Disease Program, Medical University of Vienna Division of Cardiology, Vienna, Austria"
      ],
      "name": "Harald Gabriel"
    },
    {
      "affiliations": [
        "Department of Cardiology, Inselspital University Hospital Bern, Bern, Switzerland"
      ],
      "name": "Fabienne Schwitz"
    },
    {
      "affiliations": [
        "Department of Cardiology, Inselspital University Hospital Bern, Bern, Switzerland"
      ],
      "name": "Mathias Possner"
    },
    {
      "affiliations": [
        "University of Bern, Bern, Switzerland",
        "Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada"
      ],
      "name": "Markus Schwerzmann"
    },
    {
      "affiliations": [
        "Adult Congenital Heart Disease Unit, Department of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain"
      ],
      "name": "Joaquín Rueda"
    },
    {
      "affiliations": [
        "Adult Congenital Heart Disease Unit, Department of Cardiology, La Fe University and Polytechnic Hospital, Valencia, Spain"
      ],
      "name": "Francisco Buendía-Fuentes"
    },
    {
      "affiliations": [
        "Department of Cardiology and Cardiac Surgery, Lausanne University Hospital, Lausanne, Switzerland",
        "Geneva University Hospitals, Geneva, Switzerland"
      ],
      "name": "Judith Bouchardy"
    },
    {
      "affiliations": [
        "Department of Cardiology and Cardiac Surgery, Lausanne University Hospital, Lausanne, Switzerland",
        "Geneva University Hospitals, Geneva, Switzerland",
        "Cardiology, Hopital Europeen Georges Pompidou, Paris, France"
      ],
      "name": "Magalie Ladouceur"
    },
    {
      "affiliations": [
        "Unitat Integrada de Cardiopaties Congènites de l’Adolescent i Adult, Vall d’Hebron University Hospital, Barcelona, Spain"
      ],
      "name": "Laura Dos-Subirà"
    },
    {
      "affiliations": [
        "Department of Cardiology, University Hospital Zurich, Zurich, Switzerland"
      ],
      "name": "Matthias Greutmann"
    },
    {
      "affiliations": [
        "Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland"
      ],
      "name": "Daniel Tobler"
    },
    {
      "affiliations": [
        "Adult Congenital Heart Disease Unit, Virgen del Rocio University Hospital Cardiology and Cardiovascular Surgery Service, Sevilla, Spain"
      ],
      "name": "Pastora Gallego"
    }
  ],
  "title": "Aortic coarctation and long-term morbidity after arterial switch operation: a multicentre international cohort study",
  "uid": "58a0a02b-2b8d-50ea-8cb4-0ded5493a2c4"
}