Analysis Of The Results Of Aortic Transposition For The Treatment Of Congenital Complete Aortic Transposition

Objective:To investigate the risk factors of neoaortic regurgitation(NAR)after the arterial switch operation(ASO)for transposition of the great arteries(TGA).Methods:This retrospective study enrolled 229 patients with TGA who underwent ASO from January 2008-2013 in our hospital,including 173 males and 56 females with an average age of 7.8 ± 15.9 months(range,3 days to 93.9 months;median,1.5 months)and an average weight of 6.3 ± 4.2 kg(range,2.4 to 18 kg;median,4 kg).Results:The mean follow-up was 62.5 ± 31.1 months(rage,36 to 98 months).Twenty eight patients(12.2%)suffered at least moderate NAR.In Kaplan-Meier survival analysis,probability of freedom from at least moderate NAR was 100.0%,100.0%,99.6%,95.3%at year 1,2,3 and 5,respectively.Univariate analysis revealed that weight and frequency of preoperative pulmonary arterial hypertension and previous morphological left ventricle retraining in patients with at least moderate NAR before ASO were more than those of other patients(8.3 ± 5.6 kg vs.5.8 ± 4.3 kg,P=0.006;50.0%vs.20.4%,P=0.001;28.6%vs.10.4%,P=0.013).Multivariate analysis showed that previous morphological left ventricle retraining(HR=3.8,P=0.005)and preoperative pulmonary arterial hypertension(HR=16.5,P<0.001)were risk factors of NAR.Conclusions:The incidence of at least moderate NAR after ASO is favorable.At least moderate NAR is associated with preoperative pulmonary arterial hypertension and previous morphological left ventricle retraining.Objective:Clinical scenario of patients with pulmonary arterial hypertension(PAH)related to complete transposition of the great arteries(TGA)after arterial switch operation(ASO)remains largely unknown.This study is to investigate mid-term outcomes focusing on patients of TGA-PAH.Methods:From 2010 to 2014,consecutive 83 patients were retrospectively included.The inclusive criteria included 1).diagnosed as TGA-unrestrictive VSD,2).age>6 months,3).underwent ASO and 4).mPAP>25 mmHg/PCWP<15mmHg.Patients co-present with collateral vessels,left ventricular outflow tract obstruction and cardiac positional abnormality were excluded.Results:Mean follow-up time is 39.6±32.4 m,a total of 83 patients were included with an overall mortality of 13.3%(11/83).Fifty patients<1 years old were divided into group 1 and the others(33 patients)>1 years old were in group 2.Eight deaths(72.7%)were related to PAH and all of them occurred within 1 year after ASO.The probability freedom from PAH related deaths,which was 93.6%,89.5%,and 89.5%at 6 months,1 year and 5 years,respectively.Only the mPAP immediately after ASO was identified as independent risk factor for mortality(OR=3.257,p=0.030)in multivariate analysis.The incidence of at least moderate neoaortic regurgitation(NAR)is 11.1%by follow-ups.Conclusions:Patients with an age<1 year can undergo ASO with favorable outcomes and have better survival rate than those older than 1 year of age.Deaths were associated with mPAP immediately after ASO.Regular oral drug is benefical for TGA-VSD-PAH patients with abnormal postoperative mPAP to undergo ASO.