title: Reoperation for neoaortic root pathology after the arterial switch operation.
abstract: OBJECTIVE
  To evaluate incidence and results of surgical intervention for neoaortic root pathology following arterial switch operation (ASO) for transposition of the great arteries (TGA).
  
  
  METHODS
  Between April 1996 and August 2013, 12 patients underwent reoperation for neoaortic root dilatation (ARD) and/or neoaortic valve regurgitation (AR). Maximal aortic sinus and annulus diameter Z-scores were recorded. Original diagnoses were TGA/IVS (6), TGA/ventricular septal defect (VSD) (4) and Taussig-Bing anomaly (2) with ASO at a median age of 0.1 (range: 0-10.6) years. Age at ASO, VSD and complex TGA were reviewed as possible risk factors for reoperation.
  
  
  RESULTS
  Twelve patients with tricuspid neoaortic valves underwent 15 root operations; indications were root dilatation (4) and root dilatation with AR (8). Median age was 18.0 (3.0-29.0) years at first reoperation. Median aortic root Z-score at reoperation was 6.33 (range: 3.84-12.15). Procedures were: Bentall procedure (6), aortic valve replacement (2), neoaortic valve plasty (1), supracoronary tube (1) and switch-back operation (2). Mean follow-up was 7.0 ± 5.7 years and complete. No mortality occurred. One patient had two reoperations for late endocarditis. Technical difficulties were encountered related to specific anatomy post-ASO concerning coronary anatomy, poor exposure and thin-walled aorta at the site of pulmonary artery bifurcation after Lecompte manoeuvre. Valve sparing surgery seemed not feasible due to specific anatomy of the neoaortic root and valve. No risk factors for reoperation could be identified.
  
  
  CONCLUSIONS
  After ASO, surgery for neoaortic root pathology may become necessary when follow-up is long enough and regardless of primary diagnosis or other risk factors. Redo neoaortic surgery can be performed with low risk taking into account the specific technical difficulties.
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Centre, Amsterdam, Netherlands Leiden University Medical Centre, Leiden, Netherlands d.r.koolbergen@lumc.nl.
authors.forename: David R
authors.initials: DR
authors.lastname: Koolbergen
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Centre, Amsterdam, Netherlands.
authors.forename: Johan S J
authors.initials: JS
authors.lastname: Manshanden
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Centre, Amsterdam, Netherlands Leiden University Medical Centre, Leiden, Netherlands.
authors.forename: Aria P
authors.initials: AP
authors.lastname: Yazdanbakhsh
authors.affiliation: Department of Cardiology, Academic Medical Centre, Amsterdam, Netherlands.
authors.forename: Berto J
authors.initials: BJ
authors.lastname: Bouma
authors.affiliation: Department of Paediatric Cardiology, Academic Medical Centre, Amsterdam, Netherlands.
authors.forename: Nico A
authors.initials: NA
authors.lastname: Blom
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Centre, Amsterdam, Netherlands.
authors.forename: Bas A J M
authors.initials: BA
authors.lastname: de Mol
authors.affiliation: Department of Cardiology, Academic Medical Centre, Amsterdam, Netherlands.
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Mulder
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Centre, Amsterdam, Netherlands Leiden University Medical Centre, Leiden, Netherlands.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Hazekamp
mesh_terms: D000293:Adolescent; D000328:Adult; D001011:Aorta / Q000473:pathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000453:epidemiology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012086:Reoperation / Q000706:statistics & numerical data*; D014188:Transposition of Great Vessels / Q000473:pathology* / Q000601:surgery*; D055815:Young Adult
keywords: Arterial switch operation; Neoaortic regurgitation; Neoaortic root dilatation; Reoperation; Transposition of the great arteries