Native Bicuspid Pulmonary Valve in D‐Loop Transposition of the Great Arteries: Outcomes of the Neo‐Aortic Valve Function and Root Dilation After Arterial Switch Operation

Background Neo‐aortic root dilation and neo‐aortic regurgitation (AR) are common after arterial switch operation for D‐loop transposition of the great arteries. We sought to evaluate these outcomes in patients with bicuspid native pulmonary valve (BNPV). Methods and Results A retrospective analysis...

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Autores principales:	Margaret Irwin, Geoffrey Binney, Kimberlee Gauvreau, Sitaram Emani, Elizabeth D. Blume, David W. Brown
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	aortic valve congenital heart disease transposition of the great arteries Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/a9667a7ce1b84473b9f0b8b07d31533d
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spelling	oai:doaj.org-article:a9667a7ce1b84473b9f0b8b07d31533d2021-11-23T11:36:34ZNative Bicuspid Pulmonary Valve in D‐Loop Transposition of the Great Arteries: Outcomes of the Neo‐Aortic Valve Function and Root Dilation After Arterial Switch Operation10.1161/JAHA.121.0215992047-9980https://doaj.org/article/a9667a7ce1b84473b9f0b8b07d31533d2021-09-01T00:00:00Zhttps://www.ahajournals.org/doi/10.1161/JAHA.121.021599https://doaj.org/toc/2047-9980Background Neo‐aortic root dilation and neo‐aortic regurgitation (AR) are common after arterial switch operation for D‐loop transposition of the great arteries. We sought to evaluate these outcomes in patients with bicuspid native pulmonary valve (BNPV). Methods and Results A retrospective analysis of patients with transposition of the great arteries undergoing arterial switch operation at Boston Children's Hospital from 1989 to 2018 matched BNPV patients 1:3 with patients with tricuspid native pulmonary valve by year of arterial switch operation. Kaplan–Meier analyses with log‐rank test compared groups for time to first neo‐aortic valve reoperation, occurrence of ≥moderate AR, and neo‐aortic root dilation (root z score ≥4). A total of 83 patients with BNPV were matched with 217 patients with tricuspid native pulmonary valve. Patients with BNPV more often had ventricular septal defects (73% versus 43%; P<0.001). Hospital length of stay (11 versus 10 days) and 30‐day surgical mortality (3.6% versus 2.8%) were similar. During median 11 years follow‐up, neo‐aortic valve reoperation occurred in 4 patients with BNPV (6.0%) versus 6 patients with tricuspid native pulmonary valve (2.8%), with no significant difference in time to reoperation. More BNPV had AR at discharge (4.9% versus 0%; P=0.014) and during follow‐up (13.4% versus 4.3%; hazard ratio [HR], 3.9; P=0.004), with shorter time to first occurrence of AR; this remained significant after adjusting for ventricular septal defects. Similarly, neo‐aortic root dilation was more common in BNPV (45% versus 38%; HR, 1.64; P=0.026) with shorter time to first occurrence. Conclusions While patients with BNPV have similar short‐term arterial switch operation outcomes, AR and neo‐aortic root dilation occur more frequently and earlier compared with patients with tricuspid native pulmonary valve. Further long‐term studies are needed to determine whether this results in greater need for neo‐aortic valve reoperation.Margaret IrwinGeoffrey BinneyKimberlee GauvreauSitaram EmaniElizabeth D. BlumeDavid W. BrownWileyarticleaortic valvecongenital heart diseasetransposition of the great arteriesDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 18 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	aortic valve congenital heart disease transposition of the great arteries Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	aortic valve congenital heart disease transposition of the great arteries Diseases of the circulatory (Cardiovascular) system RC666-701 Margaret Irwin Geoffrey Binney Kimberlee Gauvreau Sitaram Emani Elizabeth D. Blume David W. Brown Native Bicuspid Pulmonary Valve in D‐Loop Transposition of the Great Arteries: Outcomes of the Neo‐Aortic Valve Function and Root Dilation After Arterial Switch Operation
description	Background Neo‐aortic root dilation and neo‐aortic regurgitation (AR) are common after arterial switch operation for D‐loop transposition of the great arteries. We sought to evaluate these outcomes in patients with bicuspid native pulmonary valve (BNPV). Methods and Results A retrospective analysis of patients with transposition of the great arteries undergoing arterial switch operation at Boston Children's Hospital from 1989 to 2018 matched BNPV patients 1:3 with patients with tricuspid native pulmonary valve by year of arterial switch operation. Kaplan–Meier analyses with log‐rank test compared groups for time to first neo‐aortic valve reoperation, occurrence of ≥moderate AR, and neo‐aortic root dilation (root z score ≥4). A total of 83 patients with BNPV were matched with 217 patients with tricuspid native pulmonary valve. Patients with BNPV more often had ventricular septal defects (73% versus 43%; P<0.001). Hospital length of stay (11 versus 10 days) and 30‐day surgical mortality (3.6% versus 2.8%) were similar. During median 11 years follow‐up, neo‐aortic valve reoperation occurred in 4 patients with BNPV (6.0%) versus 6 patients with tricuspid native pulmonary valve (2.8%), with no significant difference in time to reoperation. More BNPV had AR at discharge (4.9% versus 0%; P=0.014) and during follow‐up (13.4% versus 4.3%; hazard ratio [HR], 3.9; P=0.004), with shorter time to first occurrence of AR; this remained significant after adjusting for ventricular septal defects. Similarly, neo‐aortic root dilation was more common in BNPV (45% versus 38%; HR, 1.64; P=0.026) with shorter time to first occurrence. Conclusions While patients with BNPV have similar short‐term arterial switch operation outcomes, AR and neo‐aortic root dilation occur more frequently and earlier compared with patients with tricuspid native pulmonary valve. Further long‐term studies are needed to determine whether this results in greater need for neo‐aortic valve reoperation.
format	article
author	Margaret Irwin Geoffrey Binney Kimberlee Gauvreau Sitaram Emani Elizabeth D. Blume David W. Brown
author_facet	Margaret Irwin Geoffrey Binney Kimberlee Gauvreau Sitaram Emani Elizabeth D. Blume David W. Brown
author_sort	Margaret Irwin
title	Native Bicuspid Pulmonary Valve in D‐Loop Transposition of the Great Arteries: Outcomes of the Neo‐Aortic Valve Function and Root Dilation After Arterial Switch Operation
title_short	Native Bicuspid Pulmonary Valve in D‐Loop Transposition of the Great Arteries: Outcomes of the Neo‐Aortic Valve Function and Root Dilation After Arterial Switch Operation
title_full	Native Bicuspid Pulmonary Valve in D‐Loop Transposition of the Great Arteries: Outcomes of the Neo‐Aortic Valve Function and Root Dilation After Arterial Switch Operation
title_fullStr	Native Bicuspid Pulmonary Valve in D‐Loop Transposition of the Great Arteries: Outcomes of the Neo‐Aortic Valve Function and Root Dilation After Arterial Switch Operation
title_full_unstemmed	Native Bicuspid Pulmonary Valve in D‐Loop Transposition of the Great Arteries: Outcomes of the Neo‐Aortic Valve Function and Root Dilation After Arterial Switch Operation
title_sort	native bicuspid pulmonary valve in d‐loop transposition of the great arteries: outcomes of the neo‐aortic valve function and root dilation after arterial switch operation
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/a9667a7ce1b84473b9f0b8b07d31533d
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Native Bicuspid Pulmonary Valve in D‐Loop Transposition of the Great Arteries: Outcomes of the Neo‐Aortic Valve Function and Root Dilation After Arterial Switch Operation

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