Abstract 15645: Long Term Results of Patients With d-Transposition of the Great Arteries and Native Bicuspid Pulmonary Valves After the Arterial Switch Operation
Background: A native bicuspid pulmonary valve (BPV) that takes on the role of the neo-aortic valve after the arterial switch operation (ASO) could be a source of increased morbidity in patients with d-transposition of the great arteries (d-TGA). The aim of this study was to evaluate the long term outcomes of d-TGA patients with a BPV who underwent ASO.
Methods: Our single-center ASO database was reviewed to identify those patients with d-TGA and a BPV between 1999 and 2011. Variables studied included age and weight at operation, BPV z-score, aortic to BPV annulus ratio, aorta and pulmonary artery alignment, coronary artery pattern, presence of ventricular septal defect, cardiopulmonary bypass and cross clamp times, and interventions on the BPV and left ventricular outflow tract (LVOT). Mortality, need for reintervention, and presence of aortic insufficiency (AI) and aortic root dilation were assessed.
Results: Of 343 patients who underwent ASO, 27 (8%) were identified in the operative note as having a BPV. Seven valves were thickened or dysmorphic, 8 had mild stenosis, and 2 had moderate stenosis. Median age and weight at operation were 6 days (range 1 day - 8 months) and 3.3 kg (1.9 - 5.9 kg), respectively. Survival to hospital discharge was 93%, as there were 2 deaths. There were no late deaths. Two patients were lost to follow up and excluded from further analysis. The mean follow up duration was 6.7 ± 3.6 years. Freedom from reintervention by cardiac catheterization or surgery was 90% and 78% at 1 and 5 years, respectively. Five patients (22%) had a reintervention including 3 on the right ventricular outflow tract and 2 pacemaker implants. No procedures were performed to address the neo-aortic valve, LVOT, or aortic root. Eight patients had mild AI, and none had moderate or severe AI. Five patients had an aortic root z-score >4. None of the variables examined were found to be significant predictors of these outcomes. All patients were in NYHA functional class I.
Conclusions: d-TGA patients with BPVs who undergo ASO are at low risk for morbidity related to these abnormal BPVs functioning in the neo-aortic position. Continued long term follow up is necessary to evaluate for development of AI and aortic root dilation, and potential need for reintervention.
- © 2013 by American Heart Association, Inc.