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Long-term predictors of aortic root dilation and aortic regurgitation after arterial switch operation Schwartz ML; Gauvreau K; del Nido P; Mayer JE; Colan SDCirculation 2004[Sep]; 110 (11 Suppl 1): II128-32BACKGROUND: Neo-aortic root dilation (ARD) and neo-aortic regurgitation (AR) may be progressive after arterial switch operation (ASO) for d-loop transposition of the great arteries (dTGA). We sought to identify predictors of ARD and AR after ASO. METHODS AND RESULTS: 335 patients were identified who underwent ASO for dTGA with intact ventricular septum or ventricular septal defect (VSD), including double-outlet right ventricle (DORV), before 2001 with at least 1 postoperative echocardiogram at our institution, at least 1 year after ASO, and no previous atrial switch procedure (median follow-up of 5.0 years). Probability of freedom from ARD was 97%, 92%, 82%, and 51%, from at least moderate AR was 98%, 97%, 96%, and 93%, and from neo-aortic valve or root surgery was 100%, 100%, 99%, and 95%, at 1, 2, 5, and 10 years, respectively. For patients in whom ARD developed, progressive dilation was not observed during late follow-up. By Kaplan-Meier method, independent predictors of ARD, with neo-aortic root z-score of > or =3.0, were previous pulmonary artery band (PAB) (P=0.002, hazard ratio [HR]=2.4) and later time period when ASO was performed (P<0.002, HR=19.0). Risk factor for at least moderate AR was age > or =1 year at ASO (P=0.002, HR=5.8), which was closely related to VSD repair at ASO (P<0.001) and previous PAB. CONCLUSIONS: Significant ARD and AR continue to develop over time after ASO, but ARD does not tend to be progressive during late follow-up. Previous PAB was a significant risk factor for ARD. Older age at time of ASO, presence of VSD, and previous PAB were risk factors for AR.|Abnormalities, Multiple/surgery[MESH]|Aortic Coarctation/surgery[MESH]|Aortic Diseases/diagnostic imaging/*epidemiology[MESH]|Aortic Valve Insufficiency/diagnostic imaging/*epidemiology[MESH]|Cohort Studies[MESH]|Dilatation, Pathologic/diagnostic imaging/epidemiology[MESH]|Disease Progression[MESH]|Double Outlet Right Ventricle/surgery[MESH]|Female[MESH]|Follow-Up Studies[MESH]|Heart Septal Defects, Ventricular/surgery[MESH]|Humans[MESH]|Infant[MESH]|Infant, Newborn[MESH]|Life Tables[MESH]|Male[MESH]|Postoperative Complications/diagnostic imaging/*epidemiology[MESH]|Proportional Hazards Models[MESH]|Retrospective Studies[MESH]|Risk Factors[MESH]|Transposition of Great Vessels/*surgery[MESH]|Treatment Outcome[MESH]|Ultrasonography[MESH] |
