Fate of the aortic root after arterial switch operation

Hutter, Paul A.; Thomeer, Bastiaan J.M.; Jansen, P.; Hitchcock, J. F.; Faber, J. A. J.; Meijboom, Erik J.; Bennink, Ger B.W.E.

doi:10.1016/s1010-7940(01)00752-7

Cited by 80 publications

(62 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…3,4 The latter hypothesis is supported by the relatively low prevalence of autograft insufficiency in the face of high prevalence of dilatation and by the observation of similar behavior of the autologous pulmonary root late after neonatal repair (arterial switch, Damus-Kaye-Stansel, or Norwood operations) of complex congenital lesions. 20 Preoperative aneurysm of the aortic root or ascending aorta appears to be a risk factor for late autograft root dilatation. This observation has been previously reported by Elkins and colleagues 4 and it has led to modification of the Ross operation to accommodate for associated aortic pathology.…”

Section: Autograft Dilatationmentioning

confidence: 99%

Fate of the Aortic Root Late After Ross Operation

et al. 2003

View full text Add to dashboard Cite

Background-The Ross operation is an alternative to mechanical aortic valve replacement in the young. Early dilatation of the pulmonary autograft root exposed to the systemic circulation has been reported. To define the prevalence of, risk factors for, and consequences of late autograft dilatation, outcome in all consecutive patients operated since May 1994 was reviewed. Methods and Results-Ninety one patients, 77 males and 14 females, with at least 1 year of follow-up underwent cross-sectional clinical and echocardiographic examination. Age at operation was 27Ϯ10 years (range 6 to 49), and the indication was aortic regurgitation in 54 (59%) patients and bicuspid valve was present in 62 (68%). End-points of the study were freedom from autograft dilatation (root diameter Ͼ4 cm or 0.21 cm/m 2 ), from (moderate) autograft regurgitation and from reoperation. Follow-up (4.0Ϯ1.9, range 1 to 8 years) autograft root diameters were anulus, 29Ϯ4 mm (18 -39); sinus of Valsalva, 38Ϯ7 mm (24 -53); sinotubular junction, 37Ϯ6 mm (23-54); and ascending aorta, 37Ϯ5 mm (27-54). Late autograft dilatation was identified in 31 (34%) patients and regurgitation in 13 (14%), 7 of whom had autograft dilatation. At 7 years, freedom from dilatation was 42Ϯ8%, freedom from regurgitation was 75Ϯ8%, and freedom from reoperation was 85Ϯ10%. Cox proportional hazard analysis identified younger age (Pϭ0.05), preoperative sinus of Valsalva (Pϭ0.02), root replacement technique (Pϭ0.03), and absence of pericardial buttressing (Pϭ0.04) as predictive of autograft dilatation, whereas female sex (Pϭ0.002), follow-up sinus of Valsalva (Pϭ0.003), and sinotubular junction diameter (Pϭ0.02) as predictive of autograft regurgitation. Conclusions-Autograft dilatation is common late after the Ross procedure, particularly in younger patients, in those with preoperative aortic aneurysm, and those having root replacement without support of anulus and sinotubular junction. Bicuspid aortic valve is not a risk factor. Significant autograft valve dysfunction affects a minority of patients, but it is more prevalent in those with autograft dilatation.

show abstract

Section: Autograft Dilatationmentioning

confidence: 99%

Fate of the Aortic Root Late After Ross Operation

et al. 2003

View full text Add to dashboard Cite

show abstract

“…[3][4][5][6][7] With long-term follow-up, it seems that some of these patients have progressive ARD and/or AR develop and may require neo-aortic root or valve surgery. 2,8 Preoperative factors may place some patients at higher risk for these outcomes after ASO. The goal of this study was to identify risk factors associated with the development of ARD and AR and to describe the frequency and time course of ARD after ASO.…”

mentioning

confidence: 99%

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

et al. 2004

View full text Add to dashboard Cite

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 Ն3.0, were previous pulmonary artery band (PAB) (Pϭ0.002, hazard ratio [HR]ϭ2.4) and later time period when ASO was performed (PϽ0.002, HRϭ19.0). Risk factor for at least moderate AR was age Ն1 year at ASO (Pϭ0.002, HRϭ5.8), which was closely related to VSD repair at ASO (PϽ0.001) 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.

show abstract

“…However, these long-term studies have also revealed important late complications that contribute to late morbidity and the need for reoperation. These late complications include coronary artery insufficiency, right ventricular outflow tract obstruction, and problems with the native pulmonary root and pulmonary valve in the systemic position functioning as the neo-aortic root and the neo-aortic valve, respectively [13][14][15]. Dilation of the neo-aortic root has been reported in more than two-thirds of patients after ASO [16].…”

Section: Discussionmentioning

confidence: 99%