This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2005.12.061v1 47/10/2057    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (15) Citing Articles via Google Scholar Google Scholar Articles by Losay, J. Articles by Serraf, A. Search for Related Content PubMed PubMed Citation Articles by Losay, J. Articles by Serraf, A. Related Collections Related Article

CLINICAL RESEARCH: CONGENITAL HEART DISEASE

Aortic Valve Regurgitation After Arterial Switch Operation for Transposition of the Great Arteries

Incidence, Risk Factors, and Outcome

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.

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

Related Article

Aortic Regurgitation After Arterial Switch Operation

Pedro J. del Nido and Marcy L. Schwartz
J. Am. Coll. Cardiol. 2006 47: 2063-2064. [Full Text] [PDF]

This article has been cited by other articles:

				E. Angeli, S. Gerelli, C. Beyler, M. Lamerain, B. Rochas, D. Bonnet, P. Vouhe, and O. Raisky Bicuspid pulmonary valve in transposition of the great arteries: impact on outcome Eur J Cardiothorac Surg, February 1, 2012; 41(2): 248 - 255. [Abstract] [Full Text] [PDF]

				H. S. Rudra, C. Mavroudis, C. L. Backer, S. Kaushal, H. Russell, R. D. Stewart, C. Webb, and C. Sullivan The Arterial Switch Operation: 25-Year Experience With 258 Patients Ann. Thorac. Surg., November 1, 2011; 92(5): 1742 - 1746. [Abstract] [Full Text] [PDF]

				C. Mavroudis, R. D. Stewart, C. L. Backer, H. Rudra, P. Vargo, and M. L. Jacobs Reoperative Techniques for Complications After Arterial Switch Ann. Thorac. Surg., November 1, 2011; 92(5): 1747 - 1755. [Abstract] [Full Text] [PDF]

				P. Vargo, C. Mavroudis, R. D. Stewart, and C. L. Backer Late Complications Following the Arterial Switch Operation World Journal for Pediatric and Congenital Heart Surgery, January 1, 2011; 2(1): 37 - 42. [Abstract] [Full Text] [PDF]

				Endorsed by the Association for European Paediatri, Authors/Task Force Members, H. Baumgartner, P. Bonhoeffer, N. M. S. De Groot, F. de Haan, J. E. Deanfield, N. Galie, M. A. Gatzoulis, C. Gohlke-Baerwolf, et al. ESC Guidelines for the management of grown-up congenital heart disease (new version 2010): The Task Force on the Management of Grown-up Congenital Heart Disease of the European Society of Cardiology (ESC) Eur. Heart J., December 1, 2010; 31(23): 2915 - 2957. [Full Text] [PDF]

				Y.-S. Chen, I.-S. Chiu, S.-C. Huang, and S.-J. Chen Valve-sparing procedure and Lecompte maneuver in patients with late aortic regurgitation and aortic aneurysm after the arterial switch operation J. Thorac. Cardiovasc. Surg., November 1, 2010; 140(5): 1191 - 1192. [Full Text] [PDF]

				D. Tobler, W. G. Williams, A. Jegatheeswaran, G. S. Van Arsdell, B. W. McCrindle, M. Greutmann, E. N. Oechslin, and C. K. Silversides Cardiac Outcomes in Young Adult Survivors of the Arterial Switch Operation for Transposition of the Great Arteries J. Am. Coll. Cardiol., June 29, 2010; 56(1): 58 - 64. [Abstract] [Full Text] [PDF]

				K. W. Michalak, J. A. Moll, M. Moll, K. Mludzik, and J. J. Moll Neoaortic Valve Function 10 to 18 Years After Arterial Switch Operation World Journal for Pediatric and Congenital Heart Surgery, April 1, 2010; 1(1): 51 - 58. [Abstract] [Full Text] [PDF]

				K. D. H. M. Vandekerckhove, N. A. Blom, S. Lalezari, D. R. Koolbergen, M. E. B. Rijlaarsdam, and M. G. Hazekamp Long-term follow-up of arterial switch operation with an emphasis on function and dimensions of left ventricle and aorta Eur J Cardiothorac Surg, April 1, 2009; 35(4): 582 - 588. [Abstract] [Full Text] [PDF]

				R. Lange, J. Cleuziou, J. Horer, K. Holper, M. Vogt, P. Tassani-Prell, and C. Schreiber Risk factors for aortic insufficiency and aortic valve replacement after the arterial switch operation Eur J Cardiothorac Surg, October 1, 2008; 34(4): 711 - 717. [Abstract] [Full Text] [PDF]

				E. Angeli, O. Raisky, D. Bonnet, D. Sidi, and P. R. Vouhe Late reoperations after neonatal arterial switch operation for transposition of the great arteries Eur J Cardiothorac Surg, July 1, 2008; 34(1): 32 - 36. [Abstract] [Full Text] [PDF]

				T. Bove, F. De Meulder, G. Vandenplas, K. De Groote, J. Panzer, B. Suys, D. DeWolf, and K. Francois Midterm Assessment of the Reconstructed Arteries After the Arterial Switch Operation Ann. Thorac. Surg., March 1, 2008; 85(3): 823 - 830. [Abstract] [Full Text] [PDF]

				G. Agnoletti, P. Ou, D. S. Celermajer, Y. Boudjemline, D. Marini, D. Bonnet, and Y. Aggoun Acute angulation of the aortic arch predisposes a patient to ascending aortic dilatation and aortic regurgitation late after the arterial switch operation for transposition of the great arteries J. Thorac. Cardiovasc. Surg., March 1, 2008; 135(3): 568 - 572. [Abstract] [Full Text] [PDF]

				J. Klcovansky, L. Sondergaard, M. Helvind, and H. O. Andersen Cardiac surgery in grown-up congenital heart patients. Will the surgical workload increase? Interact CardioVasc Thorac Surg, February 1, 2008; 7(1): 84 - 89. [Abstract] [Full Text] [PDF]

				A. Yamazaki, N. Yamamoto, T. Sakamoto, K. Ishihara, Y. Iwata, G. Matsumura, and H. Kurosawa Long-term outcomes and social independence level after arterial switch operation Eur J Cardiothorac Surg, February 1, 2008; 33(2): 239 - 243. [Abstract] [Full Text] [PDF]

				S. M. Khan, A. B. Sallehuddin, Z. R. Al-Bulbul, and Z. Y. Al-Halees Neoaortic Bicuspid Valve in Arterial Switch Operation: Mid-Term Follow-Up Ann. Thorac. Surg., January 1, 2008; 85(1): 179 - 184. [Abstract] [Full Text] [PDF]

				T. P. Graham Jr The Year in Congenital Heart Disease J. Am. Coll. Cardiol., July 24, 2007; 50(4): 368 - 377. [Full Text] [PDF]

				J. A. Hawkins, P. C. Kouretas, R. Holubkov, R. V. Williams, L. Y. Tani, J. T. Su, L. M. Lambert, C. R. Mart, M. D. Puchalski, and L. L. Minich Intermediate-term results of repair for aortic, neoaortic, and truncal valve insufficiency in children J. Thorac. Cardiovasc. Surg., May 1, 2007; 133(5): 1311 - 1317. [Abstract] [Full Text] [PDF]

				A. N. DeMaria, O. Ben-Yehuda, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, W. Y.W. Lew, J. A.C. Lima, A. S. Maisel, J. Narula, D. J. Sahn, et al. Highlights of the Year in JACC 2006 J. Am. Coll. Cardiol., January 30, 2007; 49(4): 509 - 527. [Full Text] [PDF]

				P. J. del Nido and M. L. Schwartz Aortic Regurgitation After Arterial Switch Operation J. Am. Coll. Cardiol., May 16, 2006; 47(10): 2063 - 2064. [Full Text] [PDF]