CLINICAL RESEARCH: CONGENITAL HEART DISEASE
Aortic Valve Regurgitation After Arterial Switch Operation for Transposition of the Great Arteries
Incidence, Risk Factors, and Outcome
Jean Losay, MD*,
Anita Touchot, MD,
Andre Capderou, MD, PhD,
Jean-Dominique Piot, MD,
Emre Belli, MD,
Claude Planché, MD, PhD and
Alain Serraf, MD, PhD
Centre Chirurgical Marie-Lannelongue, Le Plessis-Robinson, France.
Manuscript received July 22, 2005;
revised manuscript received November 25, 2005,
accepted December 11, 2005.
* Reprint requests and correspondence: Dr. Jean Losay, Centre Chirurgical Marie-Lannelongue, 133 avenue de la Résistance, 92350 Le Plessis-Robinson, France. (Email: jlosay{at}ccml.fr).
OBJECTIVES: The aims of this study were to assess the prevalence and incidence of aortic valve regurgitation (AR) after arterial switch operation (ASO), its outcome, and the risk factors.
BACKGROUND: After an ASO, the long-term fate of the aortic valve is a concern as follow-up lengthens.
METHODS: Operative and follow-up data on 1,156 hospital survivors after ASOs between 1982 and December 2000 were reviewed.
RESULTS: At last follow-up (mean duration 76.2 ± 60.5 months), 172 patients (14.9%) had an AR. Complex transposition of the great arteries, prior pulmonary banding done in 75 patients (21 with intact ventricular septum), aortic arch anomalies, AR at discharge, older age at ASO, and aortic/pulmonary size discrepancy were associated with AR. On multivariate analysis, the presence of a ventricular septal defect (VSD) or AR at discharge multiplied the risk by 2 and 4, respectively. Freedom from AR was 77.9% and 69.5% at 10 and 15 years, respectively; hazard function for AR declined rapidly and slowly increased thereafter. Reoperation from AR was done in 16 patients with one death, valvuloplasty being unsuccessful. Freedom from reoperation for AR was 97.7% and 96.8% at 10 and 15 years, respectively; hazard function slowly increased from 2 to 16 years. Higher late mortality was not associated with AR.
CONCLUSIONS: After ASO, AR was observed and was related to VSD with attending high pressure and flow and AR at discharge. Progression of AR was slow, but incidence increased with follow-up. Reoperation for AR was rare. Late aortic valve function warrants long-term monitoring.
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Abbreviations and Acronyms
| | AR = aortic regurgitation | | ASO = arterial switch operation | | CI = confidence interval | | IVS = intact ventricular septum | | LV = left ventricle | | PA = pulmonary artery | | PAB = pulmonary artery banding | | TGA = transposition of the great arteries | | VSD = ventricular septal defect |
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