1. Presenter: Shoujun Li, Kai Ma Department of Pediatric Cardiac Surgery, Fuwai hospital & National Center for Cardiovascular Disease, PUMC&CAMS, Beijing, China Neo-aortic Valve Regurgitation after Arterial Switch: Ten Years Outcomes from A Single Center

2. Disclosure No relationship to disclose

3. Background Arterial switch operation （ ASO ）  The procedure of choice: Ventriculoarterial discordance  Favorable outcomes acquired Less coronary lesion, Low mortality…  Pulmonary valve Neo-aortic valve Long-term neoaortic regurgitaiton (NAR) ? Circulation 2004, 110:II-128-II-132 J Am Coll Cardiol 2006;47:2057– 62

4. Background  Different histological nature between pulmonary and aortic root  Unfavorable neo-aortic root geometry Suture placement AO:PA diameter discrepancy Previous pulmonary banding Mechanism of NAR J Thorac Cardiovasc Surg. 2003 Oct;126(4):1053-60. Ann Thorac Surg 2008;85:823–30.

5. Aims  To report the results of NAR after ASO for TGA & CTGA incidence? risk factors?  To determine the role of neo-aortic sino-tubular junction reconstruction (NSJR)

6.  2003-2013 ， 614 consecutive pts  Groups: TGA group, n=583 CTGA group, n=31  All pts underwent ASO (as part of double switch in CTGA) Methods

7. To favor the neo-aortic root geometry Indicated when two great vessels is discrepant PA:AO diameter ratio > 2:1 Neo-aortic wall folding: At the sino-tubular junction (STJ) level Goal of reconstruction: STJ : aortic annulus diameter ratio < 0.8 NSJR technique

8. Results Patients characteristics More previous PAB, more positional anomalies and older at repair in CTGA group

9. Estimated survival  TGA group ： 1y ： 93% 3y ： 93% 5y ： 92.7%  CTGA group ： 1y ： 83.9% 3y ： 74.9% 5y ： 74.9% Higher mortality in CTGA Results Mortality

10.  Higher incidence of NAR in CTGA group  Risk factor for NAR in CTGA: Nothing identified (small sample size?)  Risk factor for NAR in TGA: Prior PAB & AO:PA diameter discrepancy Results NAR

11. Propensity matching: 30 NSJR patients & 30 Non-NSJR patients Balanced baseline data between groups Results NSJR

12. No technical difficulty: Same CPB time and cross-clamp time No Significant NAR noted in NSJR group at follow-up Statistically less NAR were noted in NSJR group at follow-up Results NSJR

13.  5 reoperations (3 TGA & 2 CTGA)  2 CTGA pts all underwent prior PAB  All valve replaced, no valvuloplasty (for enlarged annlus and unfavorable anatomy)  Time duration from ASO to reoperation :50.1±19.5 m  Optimal result achieved No death and no valvular dysfunction noted at follow-up Results Neo-aortic reoperation

14. Conclusion  ASO for TGA: optimal outcomes (less NAR, less reoperation)  DS for CTGA: higher mortality, more NAR May related to the diagnosis itself  Significant NAR may associated with prior PAB & AO:PA discrepancy  Patients with AO:PA discrepancy may benefit from NSJR  Aortic replacement is effective as neo-aortic reoperation

15. Thank you for your attention email: drlishoujun@yahoo.com drmakaifw@yahoo.com