Long-term predictors of aortic root dilation and aortic regurgitation after arterial switch operation

Circulation. 2004 Sep 14;110(11 Suppl 1):II128-32. doi: 10.1161/01.CIR.0000138392.68841.d3.


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 > or =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 > or =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.

Publication types

  • Review

MeSH terms

  • Abnormalities, Multiple / surgery
  • Aortic Coarctation / surgery
  • Aortic Diseases / diagnostic imaging
  • Aortic Diseases / epidemiology*
  • Aortic Valve Insufficiency / diagnostic imaging
  • Aortic Valve Insufficiency / epidemiology*
  • Cohort Studies
  • Dilatation, Pathologic / diagnostic imaging
  • Dilatation, Pathologic / epidemiology
  • Disease Progression
  • Double Outlet Right Ventricle / surgery
  • Female
  • Follow-Up Studies
  • Heart Septal Defects, Ventricular / surgery
  • Humans
  • Infant
  • Infant, Newborn
  • Life Tables
  • Male
  • Postoperative Complications / diagnostic imaging
  • Postoperative Complications / epidemiology*
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors
  • Transposition of Great Vessels / surgery*
  • Treatment Outcome
  • Ultrasonography