ABC | Volume 111, Nº1, July 2018

Original Article Mid- and Longterm Neo-Aortic Valve Regurgitation after Jatene Surgery: Prevalence and Risk Factors Cristiane Nunes Martins, 1 Bayard Gontijo Filho, 1 Roberto Max Lopes, 1 Francisco das Chagas Lima e Silva 2 BIOCOR Hospital de Doenças Cardiovasculares, 1 Belo Horizonte, MG - Brazil Hospital Santa Casa de Belo Horizonte, 2 Belo Horizonte, MG - Brazil Mailing Address: Cristiane Nunes Martins • Rua Mares de Montanha, 4790. Postal Code 34000-000, Vale dos Cristais, Nova Lima, MG – Brazil E-mail: cristianemar@hotmail.com Manuscript received October 23, 2017, revised manuscript December 19, 2017, accepted April 25, 2018 DOI: 10.5935/abc.20180111 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). (Arq Bras Cardiol. 2018; 111(1):21-28) Keywords: Heart Defects, Congenital; Transposition of Great Vessels; Transposition of Large Vessels, Aortic Valve Insufficiency. Introduction Transposition of the great arteries (TGA) has been known for almost 300 years. 1 In 1797, Matthew Baille described a condition in which the aorta originated from the right ventricle and the pulmonary artery, from the left ventricle. 2 In 1814, Farré used the term “ transposition” to characterize the malformation described by Baillie. The history of the surgical correction of TGA begins in the 1950s with palliative procedures, progressing to techniques of atrial correction (Mustard/Senning). 3 The surgical treatment of TGA was modified with the publication of the anatomical correction technique by Adib Jatene 4 in 1976, changing patients’ outcome. Throughout the years, thus, the Jatene surgery has been established as the arterial switch operation of choice, with complete physiological and anatomical corrections. Its superiority has been corroborated by long-term results showing the preservation of good left ventricular (LV) function 5 and sinus rhythm, as well as low mortality, with a survival rate over 88% in the 10-to-15-year follow-up. 6 Complications are not frequent in the immediate postoperative period, being mainly related to the patient’s preoperative condition, prolonged cardiopulmonary bypass duration and coronary artery obstruction, with consequent myocardial ischemia. Despite the excellent clinical outcome of most patients in the mid and long run, 5 the rate of late reoperation is significant after the Jatene surgery. The major reasons for reintervention are right ventricular (RV) outflow tract and coronary obstructions and progressive neo-aorta dilation associatedwith aortic regurgitation. Although technical modifications have determined a significant reduction in reinterventions for RV outflow tract 7 and coronary obstructions, 8 the late progression of neo-aorta dilation and neo‑aortic valve regurgitation is of great concern. This study was aimed at investigating the factors that could contribute to the progression of neo-aortic valve regurgitation by use of a retrospective review of a group of patients who had had surgery at a single institution. 21