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Risk Factors for Neo-Aortic Root Enlargement and Aortic Regurgitation Following Arterial Switch Operation

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Abstract

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.

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Acknowledgements

Dr. McMahon is supported by an Abercrombie research grant from the Department of Pediatric Cardiology, Texas Children’s Hospital.

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Authors and Affiliations

  1. Lillie Frank Abercrombie Division of Pediatric Cardiology, Texas Children’s Hospital and Baylor College of Medicine, 6621 Fannin, Houston, 77030, TX, USA

    C. J. McMahon, S. W. Denfield, R. H. Pignatelli, C. A. Altman & N. A. Ayres

  2. Department of Pediatric Cardiology, Johns Hopkins University, 600 N Wolfe Street, Baltimore, MD, USA

    W. J. Ravekes

  3. Department of Biostatistics, Children’s Nutrition and Research Center, Houston, TX, USA

    E. O’Brian Smith

Authors
  1. C. J. McMahon
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  2. W. J. Ravekes
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  3. E. O’Brian Smith
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  4. S. W. Denfield
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  5. R. H. Pignatelli
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  6. C. A. Altman
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  7. N. A. Ayres
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Correspondence to C. J. McMahon.

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McMahon, C., Ravekes, W., O’Brian Smith, E. et al. Risk Factors for Neo-Aortic Root Enlargement and Aortic Regurgitation Following Arterial Switch Operation. Pediatr Cardiol 25, 329–335 (2004). https://doi.org/10.1007/s00246-003-0483-6

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