Aorto-Pulmonary Mismatch (APM) in Transposition of the Great Arteries
(TGA) may be accountable for dilatation of neoaortic root and
regurgitation of neoaortic valve as late complications of ASO. The
manuscript from Arcieri et al. highlights an important aspect about ASO
technique: should we approach APM during ASO and what would be the best
strategy to do so? Techniques to approach APM at the time of ASO have
been published sporadically and are very rarely employed by surgeons.
Reconstruction of the neoaorta is generally achieved by trimming of the
suture line between pulmonary root (neoaortic root) and ascending aorta
resulting in an abnormal dilated and bulky neoaortic root already at the
time of ASO. Reduction of the pulmonary root dimension by ressection of
a fragment of the pulmonary artery wall possibly results in a more
homogenous neoaorta with consequent better hemodynamics. We believe that
approaching APM during ASO will have a compelling positive impact in the
late survival of the patients with complex TGA.