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(Circulation. 2004;110:II-128 – II-132.)
© 2004 American Heart Association, Inc.

Surgery for Congenital Heart Disease

Long-Term Predictors of Aortic Root Dilation and Aortic Regurgitation After Arterial Switch Operation

Marcy L. Schwartz, MD; Kimberlee Gauvreau, ScD; Pedro del Nido, MD; John E. Mayer, MD; Steven D. Colan, MD

From Department of Cardiology (M.L.S., K.G., S.D.C.), Children’s Hospital and Department of Pediatrics, Harvard Medical School, Boston, Mass; Department of Cardiac Surgery (P.d.N., J.E.M.), Children’s Hospital and Department of Surgery, Harvard Medical School, Boston, Mass.

Correspondence to Marcy L. Schwartz, MD, Department of Cardiology, Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115. E-mail Marcy.Schwartz{at}cardio.chboston.org

Background— 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 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 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.

Key Words: transposition of great vessels • aorta • heart defects • congenital • pediatrics • echocardiography