Abstract
Objective. To evaluate changes in dimension of neo-aortic annulus and aortic root after arterial switch operation (ASO), performed
in a single step, and to identify risk factors for developing abnormal neo-aortic root enlargement and aortic regurgitation (AR).
Material and methods. A retrospective review of all patients with d-transposition of the great arteries (d-TGA) who underwent ASO
from 2009 to 2014 was performed. There were 100 patients: 57 patients had simple d-TGA, 32 had d-TGA with ventricular septal
defect (VSD), 7 had d-TGA with aortarctia and VSD, and 4 had a Taussig-Bing heart. The median duration of follow-up was
12 months (range 12-60). The median age was 15 days (range 1-82 days), the average weight - 3,6 kg (range 2,8-5,5 kg). Serial
echocardiograms were reviewed to measure neo-aortic root (Z-Scores) and to determine progression of AR.
Results. For potential risk factors in the development of AR and/or dilatation of the aorta were
taken: weight and age before ASO,
the presence of VSD, aortarctia and variations of coronary arteries transplantation. 31 patients had neoaortic root dilatation with
Z-Scores of 2.5 or greater (3.46 ± 1.25, p =0.01). Freedom from neoaortic root dilatation at 12th, 24th, 36th, 48th and 60th months
after ASO was 93.6, 80.5, 52.7, 30.1 and 15.1% respectively. Risk factors for root dilatation include history of VSD (OR 1.47;
CI 1.01-5,01; p = 0.037) and age before surgery (OR 1.03; CI 1.00-1.07; p =0.035). 5 patients had moderate neoaortic valve regurgitation.
Probability of freedom from at least moderate AR dilatation at 12th, 36th and 48th months after ASO was 97.4, 92.4 and
86.1% respectively. Neoaortic root dilatation with Z-Score > 2.5 (OR 2.03; CI 1.13-4.68; p =0.004) and history of VSD (OR 17.73;
CI 1.03-34.95; p =0,048) were significant risk factors for neoaortic valve regurgitation (p < 0 .0001). The relationship between the
development of neoaortic root dilatation and coronary artery transplantation technique has not been determined. No patient required
reintervention on neo-aorta or neoaortic valve.
Conclusion. Neo-aortic root dilatation and aortic regurgitation are common complications in patients with TGA after ASO. The risk
of these events is much higher in patients with TGA combined with VSD, as well as directly related to preoperative age of a patient.
Neo-aortic root dilation progresses over time, but aortic valve regurgitation occurs infrequently. These complications do not require
surgical correction for a long time.
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