Department   School of Medicine(Yachiyo Medical Center), School of Medicine
   Position   Assistant Professor
Article types Original article
Language English
Peer review Peer reviewed
Title Late Neo-Aortic Valve Regurgitation Long After Arterial Switch Operation.
Journal Formal name:The Annals of Thoracic Surgery
Abbreviation:Ann Thorac Surg
ISSN code:00034975/15526259
Domestic / ForeginForegin
Publisher Elsevier
Volume, Issue, Page 108(4),pp.1210-1216
Author and coauthor NAKAYAMA Yuki†*, SHINKAWA Takeshi, MATSUMURA Goki, HOUKI Ryogo, KOBAYASHI Kei, NIINAMI Hiroshi
Publication date 2019/10
Summary BACKGROUND:The purpose of this study is to assess risk factors of neo-aortic regurgitation (AR) after an arterial switch operation and outcomes of neo-aortic valve surgery.

METHODS:This is a retrospective study of 469 hospital survivors after arterial switch operation from 1982 to 2016. Preoperative diagnoses included 285 transpositions of the great arteries with intact septum, 140 transpositions with ventricular septal defect, and 44 double-outlet right ventricles. More than mild preoperative pulmonary regurgitation was found in 15 patients. Median age at the operation was 1.0 months (range, 0.1-81.5). Concomitant relief of left ventricular outflow tract obstruction was performed in 20 patients. Seventy-seven patients had more than mild neo-AR at hospital discharge.

RESULTS:More than moderate neo-AR was found in 41 patients (8.6%) at a median follow-up of 19.0 years (range, 0.1-35.2). Multivariate analysis identified more than mild preoperative pulmonary regurgitation, concomitant relief of left ventricular outflow tract obstruction, and more than mild neo-AR at hospital discharge as risk factors for late neo-AR. Seventeen patients (3.6%) underwent neo-aortic valve surgeries, including 11 aortic valve replacements, 3 aortic valve plasties, 2 Konno procedures, and 1 aortic root replacement, with median age at the neo-aortic valve surgery of 16.5 years (range, 6.2-27.3). There were 2 late deaths and 5 reoperations to the neo-aortic valve in 4 patients.

CONCLUSIONS:Concomitant relief of left ventricular outflow tract obstruction and preoperative more than mild pulmonary regurgitation increase the risk of neo-AR after the arterial switch operation. Reoperation for neo-AR can be done safely.
DOI 10.1016/j.athoracsur.2019.04.009
PMID 31077656