Aortic valve regurgitation after arterial switch operation for transposition of the great arteries: incidence, risk factors, and outcome.
OBJECTIVE
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.
Losay
Jean
J
Centre Chirurgical Marie-Lannelongue, Le Plessis-Robinson, France. jlosay@ccml.fr
Touchot
Anita
A
Capderou
Andre
A
Piot
Jean-Dominique
JD
Belli
Emre
E
Planché
Claude
C
Serraf
Alain
A
D001011:Aorta / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000453:epidemiology* / Q000209:etiology; D018376:Cardiovascular Abnormalities / Q000150:complications / Q000601:surgery; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects*; D003331:Coronary Vessels / Q000601:surgery; D005500:Follow-Up Studies; D006345:Heart Septal Defects, Ventricular / Q000150:complications*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015995:Prevalence; D016016:Proportional Hazards Models; D011651:Pulmonary Artery / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D014188:Transposition of Great Vessels / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome