Risk Factors for Neo-Aortic Root Enlargement and Aortic Regurgitation Following Arterial Switch Operation
- 366 Downloads
The objectives of this study were to evaluate changes in dimension of the neo-aortic annulus, aortic root, and aortic anastomosis following arterial switch operation (ASO) and to identify risk factors for developing abnormal neo-aortic root enlargement and aortic regurgitation (AR). Prior studies report development of neo-aortic root dilatation and AR in a small subset of patients after ASO. Predisposing factors for neo-aortic root dilatation and development of moderate/severe AR are poorly understood. We performed a retrospective review of all patients with d-transposition of the great arteries (d-TGA) or double-outlet right ventricle with subpulmonary ventricular septal defect (VSD) who underwent ASO from May 1986 to January 2001. Serial echocardiograms were reviewed to measure neo-aortic annulus, root, and anastomosis diameter (z scores) and to determine progression of AR. Potential risk factors were assessed for developing neo-aortic root enlargement and AR. There were 119 patients (44 female and 75 male): 73 patients had simple d-TGA, 36 had d-TGA with ventricular septal defect, and 10 had a Taussig–Bing heart. The median duration of follow-up was 65 months (range, 12–180). The median neo-aortic root (z = 0.55 ± 2.2; p < 0.01) and aortic annulus dimensions (z = 1.57 ± 1.75; p < 0.01) were significantly increased over the study period. Aortic anastomosis diameter correlated with growth of the ascending aorta (z = 0.55 ± 1.24). Development of severe neo-aortic root enlargement was associated with prior pulmonary artery (PA) banding (p < 0.01), the presence of a VSD (p = 0.03), and Taussig–Bing anatomy (p < 0.01) but was independent of coronary arterial anatomy, coronary arterial transfer technique, or associated lesions (p > 0.05). At latest follow-up, there was no or trivial AR in 88 patients, mild AR in 29 patients, and moderate to severe AR in 3 patients. Risk factors for developing mild or worse AR included severe or rapid neo-aortic root dilatation (p < 0.01). Only 3 patients required surgical intervention for AR. Despite the significant prevalence of neo-aortic root enlargement at intermediate follow-up after ASO, there is a low incidence of significant AR. Prior PA banding, the presence of VSD, and Taussig–Bing anatomy are risk factors for severe root enlargement. Surgical intervention for AR was rare (2%), however, serial surveillance of such patients is vital to monitor for neo-aortic root enlargement and potential aortic valve dysfunction.
KeywordsArterial switch operation Transposition of the great arteries Aortic regurgitation Neo-aorta
Dr. McMahon is supported by an Abercrombie research grant from the Department of Pediatric Cardiology, Texas Children’s Hospital.
- 1.Angouros, D, Sokolis, DP, Dosios, T, et al. 2000Effect of impaired vasa vasorum flow on the structure and mechanics of the thoracic aorta: implications for the pathogenesis of aortic dissection.Eur J Cardiothoracic Surg17468473Google Scholar
- 4.Formigari, R, Giardini, A, Bonvicini, M 2001Incidence and predictive factors of neoaortic regurgitation after arterial switch operation.J Am Coll Cardiol (suppl).471AGoogle Scholar
- 5.Gittenberger-de Groot, AC, Sauer, U, Oppenheimer Dekker, A 1983Coronary arterial anatomy in transposition of the great arteries: a morphological study.Pediatr Cardiol41524Google Scholar
- 8.Jatene, AD, Fontes, VF, Paulista, PP, et al. 1975Successful anatomic correction of transposition of the great vessels. A preliminary report.Arq Bras Surg28609618Google Scholar
- 9.Jenkins, KJ, Hanley, FL, Colan, SD, et al. 1991Function of the anatomic pulmonary valve in the systemic circulation.Circulation84173179Google Scholar
- 10.Lacour-Gayet, F, Piot, D, Zoghbi, J, Serraf, A, et al. 2001Surgical management and indication of left ventricular retraining in arterial switch operation for transposition of the great arteries with intact ventricular septum.Eur J Cardiothorac Surg202429Google Scholar
- 11.Lecompte, Y, Neveux, JY, Leca, F, et al. 1982Reconstruction of the pulmonary outflow tract without prosthetic conduit.J Thorac Cardiovasc Surg54727733Google Scholar
- 12.Losay, J, Touchat, A, Serraf, A, et al. 2001Late outcome after arterial switch operation for transposition of the great arteries.Circulation70411381142Google Scholar
- 14.Planche, C, Bruniaux, J, Lacour-Gayet, F, et al. 1998Switch operation for transposition of the great arteries in neonates. A study of 120 patients.J Thorac Cardiovasc Surg96354363Google Scholar
- 17.Schmidtke, C, Bechtel, JF, Hueppe, M, Noetzold, A, Sievers, HH 2000Size and distensibility of the aortic root and aortic valve function after different techniques of the Ross procedure.J Thorac Cardiovasc Surg11990997Google Scholar