Risk factors of neoaortic regurgitation after arterial switch operation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QILei ,  LIShoujun , YANJun , YANGKeming , HUAZhongdong , ZHANGHao , WANGXu , PANXiangbin , GAOHuawei , CHENQiuming , ZHANGSen

Department of Pediatric Cardiovascular Surgery, National Center for Cardiovascular Diseases & Fu Wai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding author：

LIShoujun, Email: drlishoujun@yahoo.com

Keywords：

Transposition of the great arteries; arterial switch operation; neoaortic regurgitation

DOI：

10.7507/1007-4848.201608053

Video：

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Objective To investigate the risk factors of neoaortic regurgitation (NAR) after the arterial switch operation (ASO) for transposition of the great arteries (TGA). Methods This retrospective study enrolled 229 patients with TGA who underwent ASO from January 2008-2013 in Fu Wai Hospital, including 173 males and 56 females with an average age of 7.8±15.9 months (range, 3 days to 93.9 months; median, 47 days) and an average weight of 6.3±4.2 kg (range, 4 to18 kg; median, 2.4 kg). Results The mean follow-up was 62.5±31.1 months and the shortest was 36 months. Twenty eight patients (12.2%) suffered at least moderate NAR. In Kaplan-Meier survival analysis, probability of freedom from at least moderate NAR was 100.0%, 100.0%, 99.6%, 95.3% at year 1, 2, 3 and 5, respectively. Univariate analysis revealed that weight and frequency of preoperative pulmonary arterial hypertension and previous pulmonary artery banding in patients with at least moderate NAR before ASO were more than those of other patients (8.3±5.6 kgvs. 5.8±4.3 kg,P=0.006; 50.0%vs. 20.4%,P=0.001; 28.6%vs. 10.4%,P=0.013). Multivariate analysis showed that previous pulmonary artery banding (HR=3.8,P=0.005) and preoperative pulmonary arterial hypertension (HR=16.5,P<0.001) were risk factors of NAR. Conclusion The incidence of at least moderate NAR after ASO is favorable. At least moderate NAR is associated with preoperative pulmonary arterial hypertension and previous pulmonary artery banding.

Citation： QILei, LIShoujun, YANJun, YANGKeming, HUAZhongdong, ZHANGHao, WANGXu, PANXiangbin, GAOHuawei, CHENQiuming, ZHANGSen. Risk factors of neoaortic regurgitation after arterial switch operation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(2): 93-97. doi: 10.7507/1007-4848.201608053 Copy

1.	徐志伟. 小儿心脏手术学. 北京: 人民军医出版社, 2006. 455-456.
2.	Paul MH. Heart disease in infants, children and adolescents. Baltlmore: Williams and Wilkins Press, 1978. 301-337.
3.	Jatene AD, Fontes VF, Paulista PP, et al. Anatomic correction of transposition of the great vessels. J Thorac Cardiovasc Surg, 1976, 72(3): 364-370.
4.	Khairy P, Clair M, Fernandes SM, et al. Cardiovascular outcomes after the arterial switch operation for D-transposition of the great arteries. Circulation, 2013, 127(3): 331-339.
5.	Villafane J, Lantin-Hermoso MR, Bhatt AB, et al. D-transposition of the great arteries: the current era of the arterial switch operation. J Am Coll Cardiol, 2014, 64(5): 498-511.
6.	Sarris GE, Chatzis AC, Giannopoulos NM, et al. The arterial switch operation in Europe for transposition of the great arteries: a multi-institutional study from the European Congenital Heart Surgeons Association. J Thorac Cardiovasc Surg, 2006, 132(3): 633-639.
7.	Ma K, Hua Z, Yang K, et al. Arterial switch for transposed great vessels with intact ventricular septum beyond one month of age. Ann Thorac Surg, 2014, 97(1): 189-195.
8.	张雅娟, 胡盛寿, 李守军, 等. 影响动脉转位术手术死亡的危险因素分析. 中国胸心血管外科临床杂志, 2010, 17(2): 109-113.
9.	高华炜, 李守军, 闫军, 等. 完全型大动脉转位行大动脉调转术十年 (2001～2012 年) 的变化趋势—单中心报告. 中国胸心血管外科临床杂志, 2015, 22(7): 638-641.
10.	del Nido PJ, Schwartz ML. Aortic regurgitation after arterial switch operation. J Am Coll Cardiol, 2006, 47(10): 2063-2064.
11.	Schwartz ML, Gauvreau K, del Nido PJ, et al. Long-term predictors of aortic root dilation and aortic regurgitation after arterial switch operation. Circulation, 2004, 110(11 Suppl 1): II128-II132.
12.	Losay J, Touchot A, Capderou A, et al. Aortic valve regurgitation after arterial switch operation for transposition of the great arteries: incidence, risk factors, and outcome. J Am Coll Cardiol, 2006, 47(10): 2057-2062.
13.	Co-Vu JG, Ginde S, Bartz PJ, et al. Long-term outcomes of the neoaorta after arterial switch operation for transposition of the great arteries. Ann Thorac Surg, 2013, 95(5): 1654-1659.
14.	Jaggers JJ, Cameron DE, Herlong JR, et al. Congenital Heart Surgery Nomenclature and Database Project: transposition of the great arteries. Ann Thorac Surg, 2000, 69(4 Suppl): S205-S235.
15.	Bonow RO, Carabello BA, Kanu C, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation, 2006, 114(5): e84-e231.
16.	Baruteau AE, Vergnat M, Kalfa D, et al. Long-term outcomes of the arterial switch operation for transposition of the great arteries and ventricular septal defect and/or aortic arch obstruction. Interact CardioVasc Thorac Surg, 2016, 23(2): 240-246.
17.	Prifti E, Crucean A, Bonacchi M, et al. Early and long term outcome of the arterial switch operation for transposition of the great arteries: predictors and functional evaluation. Eur J Cardiothorac Surg, 2002, 22(6): 864-873.
18.	McMahon CJ, Ravekes WJ, Smith EO, et al. Risk factors for neo-aortic root enlargement and aortic regurgitation following arterial switch operation. Pediatr Cardiol, 2004, 25(4): 329-335.
19.	Tobler D, Williams WG, Jegatheeswaran A, et al. Cardiac outcomes in young adult survivors of the arterial switch operation for transposition of the great arteries. J Am Coll Cardiol, 2010, 56(1): 58-64.
20.	Lo Rito M, Fittipaldi M, Haththotuwa R, et al. Long-term fate of the aortic valve after an arterial switch operation. J Thorac Cardiovasc Surg, 2015, 149(4): 1089-1094.
21.	Lalezari S, Hazekamp MG, Bartelings MM, et al. Pulmonary artery remodeling in transposition of the great arteries: relevance for neoaortic root dilatation. J Thorac Cardiovasc Surg, 2003, 126(4): 1053-1060.
22.	Hurle JM, Colvee E. Changes in the endothelial morphology of the developing semilunar heart valves. Anat Embryol (Berlin), 1983, 167(1): 67-83.
23.	Bobylev D, Breymann T, Boethig D, et al. Aortic root replacement in a patient with bicuspid pulmonary valve late after arterial switch operation. Thorac Cardiovasc Surg, 2013, 61(4): 316-319.
24.	Pan X, Hu S, Li S, et al. Predictors for late insufficiency of the neo-aortic valve after the switch procedure. J Heart Valve Dis, 2010, 19(6): 731-735.

1. 徐志伟. 小儿心脏手术学. 北京: 人民军医出版社, 2006. 455-456.
2. Paul MH. Heart disease in infants, children and adolescents. Baltlmore: Williams and Wilkins Press, 1978. 301-337.
3. Jatene AD, Fontes VF, Paulista PP, et al. Anatomic correction of transposition of the great vessels. J Thorac Cardiovasc Surg, 1976, 72(3): 364-370.
4. Khairy P, Clair M, Fernandes SM, et al. Cardiovascular outcomes after the arterial switch operation for D-transposition of the great arteries. Circulation, 2013, 127(3): 331-339.
5. Villafane J, Lantin-Hermoso MR, Bhatt AB, et al. D-transposition of the great arteries: the current era of the arterial switch operation. J Am Coll Cardiol, 2014, 64(5): 498-511.
6. Sarris GE, Chatzis AC, Giannopoulos NM, et al. The arterial switch operation in Europe for transposition of the great arteries: a multi-institutional study from the European Congenital Heart Surgeons Association. J Thorac Cardiovasc Surg, 2006, 132(3): 633-639.
7. Ma K, Hua Z, Yang K, et al. Arterial switch for transposed great vessels with intact ventricular septum beyond one month of age. Ann Thorac Surg, 2014, 97(1): 189-195.
8. 张雅娟, 胡盛寿, 李守军, 等. 影响动脉转位术手术死亡的危险因素分析. 中国胸心血管外科临床杂志, 2010, 17(2): 109-113.
9. 高华炜, 李守军, 闫军, 等. 完全型大动脉转位行大动脉调转术十年 (2001～2012 年) 的变化趋势—单中心报告. 中国胸心血管外科临床杂志, 2015, 22(7): 638-641.
10. del Nido PJ, Schwartz ML. Aortic regurgitation after arterial switch operation. J Am Coll Cardiol, 2006, 47(10): 2063-2064.
11. Schwartz ML, Gauvreau K, del Nido PJ, et al. Long-term predictors of aortic root dilation and aortic regurgitation after arterial switch operation. Circulation, 2004, 110(11 Suppl 1): II128-II132.
12. Losay J, Touchot A, Capderou A, et al. Aortic valve regurgitation after arterial switch operation for transposition of the great arteries: incidence, risk factors, and outcome. J Am Coll Cardiol, 2006, 47(10): 2057-2062.
13. Co-Vu JG, Ginde S, Bartz PJ, et al. Long-term outcomes of the neoaorta after arterial switch operation for transposition of the great arteries. Ann Thorac Surg, 2013, 95(5): 1654-1659.
14. Jaggers JJ, Cameron DE, Herlong JR, et al. Congenital Heart Surgery Nomenclature and Database Project: transposition of the great arteries. Ann Thorac Surg, 2000, 69(4 Suppl): S205-S235.
15. Bonow RO, Carabello BA, Kanu C, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation, 2006, 114(5): e84-e231.
16. Baruteau AE, Vergnat M, Kalfa D, et al. Long-term outcomes of the arterial switch operation for transposition of the great arteries and ventricular septal defect and/or aortic arch obstruction. Interact CardioVasc Thorac Surg, 2016, 23(2): 240-246.
17. Prifti E, Crucean A, Bonacchi M, et al. Early and long term outcome of the arterial switch operation for transposition of the great arteries: predictors and functional evaluation. Eur J Cardiothorac Surg, 2002, 22(6): 864-873.
18. McMahon CJ, Ravekes WJ, Smith EO, et al. Risk factors for neo-aortic root enlargement and aortic regurgitation following arterial switch operation. Pediatr Cardiol, 2004, 25(4): 329-335.
19. Tobler D, Williams WG, Jegatheeswaran A, et al. Cardiac outcomes in young adult survivors of the arterial switch operation for transposition of the great arteries. J Am Coll Cardiol, 2010, 56(1): 58-64.
20. Lo Rito M, Fittipaldi M, Haththotuwa R, et al. Long-term fate of the aortic valve after an arterial switch operation. J Thorac Cardiovasc Surg, 2015, 149(4): 1089-1094.
21. Lalezari S, Hazekamp MG, Bartelings MM, et al. Pulmonary artery remodeling in transposition of the great arteries: relevance for neoaortic root dilatation. J Thorac Cardiovasc Surg, 2003, 126(4): 1053-1060.
22. Hurle JM, Colvee E. Changes in the endothelial morphology of the developing semilunar heart valves. Anat Embryol (Berlin), 1983, 167(1): 67-83.
23. Bobylev D, Breymann T, Boethig D, et al. Aortic root replacement in a patient with bicuspid pulmonary valve late after arterial switch operation. Thorac Cardiovasc Surg, 2013, 61(4): 316-319.
24. Pan X, Hu S, Li S, et al. Predictors for late insufficiency of the neo-aortic valve after the switch procedure. J Heart Valve Dis, 2010, 19(6): 731-735.

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