Department School of Medicine(Yachiyo Medical Center), School of Medicine Position Assistant Professor
|Title||Late Neoaortic Valve Regurgitation Long After Arterial Switch Operation|
|Conference||The Society of Thoracic Surgeons 55th Annual Meeting|
|Promoters||The Society of Thoracic Surgeons|
|Conference Type||International society and overseas society|
|Publisher and common publisher||◎NAKAYAMA Yuki, SHINKAWA Takeshi, MATSUMURA Goki, HOUKI Ryogo, KOBAYASHI Kei, NIINAMI Hiroshi|
(city and name of the country)
|San Diego, USA|
|Summary||Purpose: The neo-aortic valve regurgitation (AR) is one of the long-term problems after arterial switch operation (ASO). The purposes of this study were to assess the incidence and the risk factors of the neo-AR after ASO and to review the outcome of surgical intervention to the neo-AR.
Methods: This is a retrospective study of 466 hospital survivors after ASO between 1982 and 2016. The patients with previous atrial switch operation were not included. Preoperative diagnosis included 306 transposition of great arteries (TGA) with intact septum, 119 TGAs with ventricular septal defect, and 41 double outlet right ventricles. Previous pulmonary artery banding was performed in 159 patients and 39 had more than trivial preoperative pulmonary valve regurgitation (PR). Median age at ASO was 1.0 (0.1-81.5) month. Thirteen patients had concomitant relief of left ventricular outflow tract obstruction. Seventy-six patients had more than mild neo-AR at hospital discharge.
Results: More than moderate neo-AR was found in 40 patients (8.6%) in the long-term, and its incidence at 20 years after ASO was 8.7%. By multivariate analysis, preoperative PR, concomitant relief of left ventricular outflow tract obstruction and more than mild neoAR at hospital discharge were identified as risk factors for late aggravation of neo-AR. Among these 40 patients with more than moderate neo-AR, 17 patients underwent surgery to the neo-aortic valve. Mean age at neo-aortic valve surgery was16.7±5.5 years. The surgery included 11 aortic valve replacements, 3 aortic valve plasties, 2 Konno procedures, and 1 root replacement with stentless bioprosthesis. There were two late deaths and 5 reoperations to the neo-aortic valve in 4 patients (all 3 patients with aortic valve plasty eventually required aortic valve replacement). The reoperation free survival after neo-aortic valve surgery at 5 and 10 years were 93.3% and 77.8%, respectively.
Conclusions: Preoperative PR, concomitant relief of left ventricular outflow tract obstruction and more than mild neo-AR at hospital discharge were identified as risk factors of aggravation of late neo-AR. The surgery to the neo-aortic valve was necessary only for small number of patients and its outcome was satisfactory.