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J Thorac Cardiovasc Surg 2003;126:1753-1759
© 2003 The American Association for Thoracic Surgery

Surgery for congenital heart disease

Prevalence and predictors of neoaortic regurgitation after arterial switch operation for transposition of the great arteries

^a Pediatric Cardiology and Cardiac Surgery, University of Bologna, Bologna, Italy
^b Pediatric Cardiology and Cardiac Surgery, "Bambino Gesù" Hospital, Rome, Italy

Presented at the Fiftieth Annual Scientific Session of the American College of Cardiology, Orlando, Fla, March 2001.

Received for publication January 20, 2003; revisions received April 1, 2003; accepted for publication June 25, 2003.

^* Address for reprints: Roberto Formigari, MD, FACC, Policlinico S. Orsola, Cardiologia e Cardiochirurgia Pediatrica, Via Massarenti 9, 40138 Bologna, Italy
r.formigari{at}mclink.it

BACKGROUND: The fate of the native pulmonary valve after arterial switch operation is still unknown and may become a cause for a secondary aortic valve operation during adult life. We evaluated the prevalence and predictive factors associated with neoaortic valvular regurgitation by a retrospective study of children who underwent arterial switch operation for transposition of the great arteries.

METHODS: The onset of neoaortic valvular regurgitation was correlated with demographic data, cardiac anatomy, surgical technique, and postoperative ventricular function. The size of the neoaortic root and ascending aorta was measured in a selected subset of patients.

RESULTS: Among 253 survivors, 173 were eligible for the study. After a median follow-up time of 8.2 years, 61 patients showed echocardiographic or angiographic evidence of valvular incompetence, which was progressive in 14 cases; this led to surgical intervention in 2 patients, and there was 1 operative death. At multivariate analysis, the onset of valvular regurgitation was correlated with the trap-door technique for coronary reimplantation (P < .01). A smooth transition from the aortic sinus to the ascending aorta, with loss of the normal sinotubular junction geometry, may be associated with valvular incompetence.

CONCLUSIONS: After arterial switch operation, there is an increasing frequency of neoaortic regurgitation, which may lead to significant valvular dysfunction later in life. The trap-door type of coronary reimplantation is associated with an increased risk for valvular dysfunction, possibly because of a distortion of the sinotubular junction geometry. For this reason, we recommend the punch technique for repair in all but the most complicated coronary pattern.