Mid- and Longterm Neo-Aortic Valve Regurgitation after Jatene Surgery: Prevalence and Risk Factors

Abstract Background: Jatene surgery became the surgical procedure of choice to repair transposition of the great arteries (TGA) in neonates and infants. Late complications, mainly related to the pulmonary outflow tract and coronary arteries, are well known. The behavior of the neo-aortic valve is a cause of concern because of its potential for requiring late reoperation. Objectives: To assess the prevalence and risk factors of neo-aortic valve regurgitation in 127 patients in the late postoperative period of the Jatene surgery. Methods: Of the 328 survivors of the Jatene surgery at the Biocor Institute from October 1997 to June 2015, all patients undergoing postoperative follow-up were contacted via telephone, 127 being eligible for the study. The patients were divided into two groups, simple TGA and complex TGA groups, with follow-up means of 6.4 ± 4.7 years and 9.26 ± 4.22 years, respectively. Echocardiography was performed with adjusted measurements (Z-score) of the neo-aortic annulus, sinus of Valsalva, sinotubular region and ascending aorta, as well as quantification of the neo-aortic valve regurgitation grade. Results: The incidence of mild neo-aortic valve regurgitation was 29% in a follow-up of 7.4 ± 4.7 years. Moderate regurgitation was identified in 24 patients with age mean (± standard-deviation) of 9.81 ± 4.21 years, 19 of whom (79%) in the complex TGA group. Those patients had a higher aortic annulus Z-score. The reoperation rate due to neo-aortic regurgitation associated with aortic dilation was 1.5%, all patients in the complex TGA group. Conclusion: This study shows that, despite the low incidence of reoperation after Jatene surgery due to neo-aorta dilation and neo-aortic valve regurgitation, that is a time-dependent phenomenon, which requires strict vigilance of the patients. In this study, one of the major risk factors for neo-aortic valve regurgitation was the preoperative pulmonary artery diameter (p < 0.001).

摘要 背景：Jatene手术已成为新生儿和婴幼儿矫正大动脉转位（TGA）的首选外科手术方法。与肺动脉出口和冠状动脉相关的晚期并发症已知。新主动脉瓣的行为引起关注，因为其可能需要晚期再次手术。目标：评估127例Jatene手术晚期术后患者中新主动脉瓣返流的发生率和风险因素。方法：自1997年10月至2015年6月，在Biocor研究所接受Jatene手术的328名存活者中，通过电话联系所有进行术后随访的患者，其中127名符合研究条件。患者被分为简单TGA组和复杂TGA组，随访中位数为6.4 ± 4.7年，9.26 ± 4.22年，分别。通过超声心动图进行测量（Z分数调整），包括新主动脉环、Valsalva窦、窦管区域和升主动脉，以及新主动脉瓣返流程度的量化。结果：在7.4 ± 4.7年的随访中，轻度新主动脉瓣返流的发生率为29%。在24名患者中发现了中度返流，平均年龄（±标准差）为9.81 ± 4.21岁，其中19名（79%）属于复杂TGA组。这些患者具有更高的主动脉环Z分数。因新主动脉瓣返流与主动脉扩张相关而再次手术的比率仅为1.5%，所有患者均为复杂TGA组。结论：本研究表明，尽管由于新主动脉扩张和新主动脉瓣返流导致的Jatene手术后再次手术的发生率较低，且为时间依赖性现象，但仍需对患者的健康状况保持严格监控。在本研究中，新主动脉瓣返流的主要风险因素之一是术前肺动脉直径（p < 0.001）。