Mid-term follow-up of neoaortic regurgitation after the arterial switch operation for transposition of the great arteries

Abstract

OBJECTIVE: The aim of this study was to determine the outcome of the neoaortic valve after the arterial switch operation for transposition of the great arteries. METHODS: A retrospective review of arterial switch operations that were performed during the period from 1991 to 2003 was conducted. We followed patients with echocardiography. When regurgitation of the neoaortic valve was observed we analyzed the risk factors. RESULTS: One hundred and three patients underwent a successful arterial switch operation. Eighty-one males and 22 females participated in the study. Follow-up period was 77+/-42 months. The age and body weight at the time of the arterial switch operation were 1.4+/-2.8 months and 3.8+/-1.0 kg, respectively. Preoperative pulmonary valve regurgitation was found in six patients (two patients had grade I and four patients had grade II). In the postoperative echocardiography, 52 patients demonstrated neoaortic valve regurgitation (26 patients had grade I, 25 patients had grade II, and 1 patient had grade III). At the last follow-up visit, 61 patients demonstrated neoaortic regurgitation (18 patients had grade I, 37 patients had grade II, 5 patients had grade III, and 1 patient had grade IV). Neoaortic valve regurgitation increased progressively with follow-up (p-value<0.01). The size discrepancy between the aorta and the pulmonary artery was correlated with neoaortic valve regurgitation (p-value=0.02). The age and body surface area, relationship of the great arteries, coronary arterial pattern, pulmonary artery banding, use of trap-door technique, myocardial ischemic time, use of total circulatory arrest, and existence of ventricular septal defect were not significant risk factors. CONCLUSIONS: Neoaortic valve regurgitation progressed after the arterial switch operation. The degree of regurgitation was more severe in patients with a size discrepancy between the aorta and the pulmonary artery preoperatively.