Neoaortic Valve Regurgitation After Arterial Switch: Ten Years Outcomes From A Single Center.

BACKGROUND: Report results of neoaortic regurgitation (NAR) after arterial switch for patients with d-transposition of the great arteries (d-TGA) and corrected transposition of the great arteries.

METHODS: From 2003 to 2013, 583 patients who underwent arterial switch operation for d-TGA and 31 patients who underwent double switch (DS) for congenitally corrected transposition of the great arteries (cc-TGA) were included in this retrospective study. Since 2011, concomitant neoaortic sinotubular junction reconstruction was performed if aorta and pulmonary artery discrepancy was present in patients with d-TGA.

RESULTS: The long-term survival rate was 92.5% (544/583) in patients with d-TGA and 74.2% (23/31) in patients with cc-TGA. More NAR developed in patients with cc-TGA than with d-TGA. Moreover, significant NAR (7.1% [38/539] versus 26.1% [(6/23], p = 0.010) and the aortic valve replacement (0.6% [3/539] versus 8.7% [2/23], p = 0.003) were less in the d-TGA group. Previous pulmonary artery banding and aortic and pulmonary artery diameter discrepancy were identified as risk factors for significant NAR in patients with d-TGA. However, no specific risk factors were identified in patients with cc-TGA. With the application of neoaortic sinotubular junction reconstruction, no significant NAR was recorded in patients with aortic and pulmonary artery discrepancy.

CONCLUSIONS: After an arterial switch operation, we report a favorable incidence of NAR and rare neoaortic valve replacement. Significant NAR was associated with aorta-pulmonary discrepancy and previous pulmonary artery banding. Patients with cc-TGA may require close monitoring. Patients with aortic and pulmonary artery diameter discrepancy may benefit from sinotubular junction reconstruction.