Neoaortic Regurgitation Detected by Echocardiography After Arterial Switch Operation: A Systematic Review and Meta-Analysis

Xander Jacquemyn; Jef Van den Eynde; Art Schuermans; Roel L F van der Palen; Werner Budts; David A Danford; William J Ravekes; Shelby Kutty

doi:10.1016/j.jacadv.2024.100878

Neoaortic Regurgitation Detected by Echocardiography After Arterial Switch Operation: A Systematic Review and Meta-Analysis

JACC Adv. 2024 Mar 7;3(4):100878. doi: 10.1016/j.jacadv.2024.100878. eCollection 2024 Apr.

Authors

Xander Jacquemyn^{1

2}, Jef Van den Eynde^{1

2}, Art Schuermans^{2

3

4}, Roel L F van der Palen⁵, Werner Budts⁶, David A Danford¹, William J Ravekes¹, Shelby Kutty¹

Affiliations

¹ Department of Pediatrics, Helen B. Taussig Heart Center, Johns Hopkins Hospital, Baltimore, Maryland, USA.
² Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
³ Program in Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA.
⁴ Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
⁵ Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands.
⁶ Congenital and Structural Cardiology, Department of Cardiovascular Sciences, UZ Leuven, KU Leuven, Leuven, Belgium.

Abstract

Background: Neoaortic root dilatation (NeoARD) and neoaortic regurgitation (NeoAR) are common sequelae following the arterial switch operation (ASO) for transposition of the great arteries.

Objectives: The authors aimed to estimate the cumulative incidence of NeoAR, assess whether larger neoaortic root dimensions were associated with NeoAR, and evaluate factors associated with the development of NeoAR during long-term follow-up.

Methods: Electronic databases were systematically searched for articles that assessed NeoAR and NeoARD after ASO, published before November 2022. The primary outcome was NeoAR, classified based on severity categories (trace, mild, moderate, and severe). Cumulative incidence was estimated from Kaplan-Meier curves, neoaortic root dimensions using Z-scores, and risk factors were evaluated using random-effects meta-analysis.

Results: Thirty publications, comprising a total of 6,169 patients, were included in this review. Pooled estimated cumulative incidence of ≥mild NeoAR and ≥moderate NeoAR at 30-year follow-up were 67.5% and 21.4%, respectively. At last follow-up, neoaortic Z-scores were larger at the annulus (mean difference [MD]: 1.17, 95% CI: 0.52-1.82, P < 0.001; MD: 1.38, 95% CI: 0.46-2.30, P = 0.003) and root (MD: 1.83, 95% CI: 1.16-2.49, P < 0.001; MD: 1.84, 95% CI: 1.07-2.60, P < 0.001) in patients with ≥mild and ≥moderate NeoAR, respectively, compared to those without NeoAR. Risk factors for the development of any NeoAR included prior pulmonary artery banding, presence of a ventricular septal defect, aorto-pulmonary mismatch, a bicuspid pulmonary valve, and NeoAR at discharge.

Conclusions: The risks of NeoARD and NeoAR increase over time following ASO surgery. Identified risk factors for NeoAR may alert the clinician that closer follow-up is needed. (Risk factors for neoaortic valve regurgitation after arterial switch operation: a meta-analysis; CRD42022373214).

Keywords: arterial switch operation; neoaortic regurgitation; neoaortic root dilatation; transposition of the great arteries.