Long-term fate of the aortic valve after an arterial switch operation

Abstract

Objective To evaluate long-term performance of the aortic valve after an arterial switch operation (ASO), in terms of regurgitation and reoperation. Methods A longitudinal analysis of patients who underwent an ASO between 1988 and 1998 at the Birmingham Children's Hospital. Any type of aortic valve surgery after ASO was censored. To determine progression of aortic valve regurgitation, cardiology follow-up and echocardiograms from the operation until 2012 were reviewed. Results A total of 362 patients underwent ASO; median age was 8 days. Ventricular septal defect was present in 151, aortic coarctation in 39, and interrupted aortic arch in 6 patients. The trap door technique was used for coronary translocation when possible; 4.1% had intramural coronaries. There were 331 alive patients; follow-up was complete at 93%; median duration was 16 years (interquartile range, 12-18.2 years). Overall survival at 10 and 20 years was 97.6% and 95.2%, respectively. Aortic valve reoperation occurred in 5 patients, giving freedom from aortic surgery of 99.3% and 97.7% at 10 and 20 years, respectively. Reoperations were aortic valve replacement (3), Bentall operation (1), and aortic valve repair (1). Freedom from ≥moderate regurgitation at 10 with 20 years was 97% to 80%, respectively. Degree of regurgitation immediately after ASO was strongly predictive of late aortic valve function: patients discharged with mild regurgitation had a significantly increased risk of progression compared with those with no regurgitation (20 years of freedom from ≥moderate regurgitation, 50% vs 96%, P =.0000). Conclusions Reoperation on the aortic valve is rarely necessary, even late after an ASO, but a significant number of patients do have late aortic regurgitation and continue to need observation.