Objective of the study was to determine the risk factors for the development of neoaortic valve failure in the long-term period after the arterial switch operation for the simple transposition of the great arteries.
Material and methods. The analysis of the structure, frequency and causes of neoaortic valve failure in the long-term period in patients with transposition of the great arteries to which the arterial switching operation was performed. The results of the clinical and instrumental examination, obtained with dynamic observation of 248 patients, who underwent surgery were. Statistical processing of the obtained data was carried out to determine the most significant risk factors in the pre-, intra- and postoperative period, which led to the development of aortic insufficiency in the distant period both in isolation and in combination with each other.
Results. The development of failure of the neo-aortic valve in the long-term period in the study group of patients was revealed in 104 (41.9%) cases. Severe insufficiency of the aortic valve was in 6 (2.4%) patients, medium degree was diagnosed in 2 (0.8%) patients and in 96 (38.7%) patients, regurgitation on aortic valve was mild or prickly. Statistically significant risk factors for the development of the investigated complication in the long-term period after the operation of arterial switching were: 1) type of anatomy of the main arteries: with the location of the aorta anterior to the pulmonary artery (O-TMA), the risk of developing a failure of the neoortic valve increases by 31.94 times (p=0.025); with the location of the aorta anteriorly and to the left of the pulmonary artery (L-TMA), the risk of developing a failure of the neoortic valve increases 26.159 times (p=0.039); 2) the diameter of the defect of the interventricular septum, with an increase in which the risk of developing a failure of the neoortic valve is increased by 1.792 times per millimeter (p<0.001).
Conclusion. The risk factors for the development of aortic valve insufficiency revealed in this study demonstrate a high impact
of anatomy and spatial relationship of the main arteries, as well as the presence and diameter of the defect of the interventricular septum
and determine the degree of risk of this complication in the long-term postoperative period.
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About the authors
- Leo A. Bockeria, Aсademician RAS and RAMS, Director; orcid.org/0000-0002-6180-2619
Inessa E. Nefedova, Cand. Med. Sc., Head of Department; orcid.org/0000-0002-9221-051X
David O. Berishvili, Cand. Med. Sc., Head of Department; orcid.org/0000-0001-7379-345X
Irina Yu. Baryshnikova, Dr. Med. Sc., Researcher; orcid.org/0000-0001-8071-2531
Dmitriy V. Adkin, Cand. Med. Sc., Pediatric Cardiologist; orcid.org/0000-0002-2184-8225