이엽성 폐동맥 판막이 대혈관 전위의 동맥 치환술 후 새로운 대동맥궁 및 대동맥 판막의 기능에 미치는 영향

Abstract

Background Neoaortic valve regurgitation which might be related to root dilatation is one of the major concerns following arterial switch operation (ASO) for transposition of the great arteries (TGA). However, the future of native bicuspid pulmonary valve (BPV) in aortic position remains unclear. This study investigated the effect of bicuspid neoaortic valve on neoaortic root morphology, function, and the long-term clinical outcomes after ASO for TGA using propensity score matching (PSM). Methods From January 1997 to December 2018, 442 patients underwent ASO for TGA. Patients who underwent staged repair (n=15), were repaired at extremely old age (> 1 year, n=9), and died before discharge (n=46), and were lack of echocardiographic data at discharge (n=20) were excluded. Among a total of 352 eligible patients, 18 patients (5.1%) had a BPV. After PSM (1:4), 15 patients with BPV and 60 corresponding patients with tricuspid pulmonary valve were enrolled for analysis. Serial echocardiography was performed to assess the morphology and function of neoaortic root. Results Baseline characteristics in both groups were similar. The median duration of follow-up was 9.9 years (4 months ~ 22.3 years). There was one late death. Freedom from reoperation at 10 years was 93.3 ± 6.4 % in bicuspid group and 87.0 ± 4.7 % in tricuspid group (p=0.84). Reoperation for aortic valve or aortic root was rarely required during follow-up. Indexed dimension (z-score) of neoaortic annulus was not increased in both groups (p=0.57), although there was a little increasing tendency in z-score of neoaortic sinus without intergroup difference (p=0.69). Deterioration in neoaortic valve function was more prominent in bicuspid group (common odds ratio; 1.40 in bicuspid group [p<0.01], and 1.12 in tricuspid group [p=0.03], p=0.03). Conclusions Arterial switch operation could be a safe option in selected patients with TGA associated with BPV without increasing the risk of reoperation. Neoaortic root dilatation was similar in both groups, although deterioration of aortic valve function was more prominent in bicuspid group, which suggests that the neoaortic valve function would be deteriorated mainly by valve itself.