Predictors for late insufficiency of the neo-aortic valve after the switch procedure

Abstract

Background and aim of the study: The study aim was to investigate the mid-term risk factors for neo-aortic regurgitation in patients with transposition of the great arteries (TGA) and Taussig-Bing malformation after the arterial switch operation (ASO).

Methods: Between February 2001 and December 2007, a total of 202 patients with TGA or Taussig-Bing malformation underwent the ASO at the authors' institution. Subsequently, 185 surviving patients (140 males, 45 females; mean age 14 +/- 28 months) were followed up in the out-patient department, using echocardiography. A multiple logistic regression analysis was performed to identify the risk factors for postoperative neo-aortic regurgitation.

Results: The mean period of follow up was 35 +/- 22 months (range: 3 to 88 months). Postoperative neo-aortic regurgitation was present in 19 patients; this was mild in 16 cases (9%) and moderate in three (2%). During the follow up, freedom from aortic regurgitation was 90%; the overall rates of freedom from aortic regurgitation at one, three, and five years were 95%, 89%, and 83%, respectively. The mid-term risk factors for neo-aortic regurgitation were ventricular septal defect (VSD) (p = 0.02), operative age >6 months (p = 0.01), and a postoperative neo-aortic valve Z-score >1 (p <0.01).

Conclusion: The ASO showed an acceptable midterm function of the aortic valve. The risk factors for postoperative neo-aortic regurgitation included VSD, operative age >6 months, and a postoperative neo-aortic valve Z-score >1.