Kirjavainen M, Happonen J M, Louhimo I
Helsinki University Central Hospital, Hospital for Children and Adolescents, Helsinki, Finland.
J Thorac Cardiovasc Surg. 1999 Mar;117(3):488-95. doi: 10.1016/s0022-5223(99)70329-6.
Few data exist for long-term results after the Senning operation for transposition of the great arteries. Sinus node dysfunction and systemic ventricular dysfunction have been the main problems. We evaluated risk factors for late death and the incidence of late death, sinus node dysfunction, and right ventricular dysfunction in 100 patients.
The study was a retrospective analysis with a mean follow-up time of 12.8 +/- 3.1 years. No patients were lost to follow-up. Patients were divided in 2 groups according to ventricular septal defect (73 simple, 27 complex). The electrocardiogram, ambulatory electrocardiogram, echocardiogram, and chest radiograph were reviewed for each patient.
The overall mortality rate was 10%. The actuarial survival was 90% (simple) and 78% (complex); the probability of staying in sinus rhythm was 34% and 7%, and the probability of normal right ventricular function was 52% and 39%, respectively, 15 years after operation. The incidence of sinus node dysfunction increased gradually over time, although the incidence of right ventricular dysfunction increased rapidly after 10 years of follow-up. Late deaths, arrhythmias, and right ventricular dysfunction were significantly more frequent in the complex group. Right ventricular dysfunction and active arrhythmias were risk factors for late death.
Long-term follow-up after the Senning operation shows increasing incidence of sinus node dysfunction and right ventricular dysfunction over time. Deteriorating right ventricular function is a major concern. Its early recognition and initiation of appropriate management to preserve cardiac function is an important follow-up goal.
关于大动脉转位行森宁手术的长期结果的数据较少。窦房结功能障碍和体循环心室功能障碍一直是主要问题。我们评估了100例患者晚期死亡的危险因素以及晚期死亡、窦房结功能障碍和右心室功能障碍的发生率。
本研究为回顾性分析，平均随访时间为12.8±3.1年。无患者失访。根据室间隔缺损情况将患者分为两组（73例为单纯型，27例为复杂型）。对每位患者的心电图、动态心电图、超声心动图和胸部X线片进行了复查。
总死亡率为10%。15年后，单纯型患者的精算生存率为90%，复杂型患者为78%；维持窦性心律的概率分别为34%和7%，右心室功能正常的概率分别为52%和39%。窦房结功能障碍的发生率随时间逐渐增加，而右心室功能障碍的发生率在随访10年后迅速上升。复杂型组晚期死亡、心律失常和右心室功能障碍的发生率明显更高。右心室功能障碍和活动性心律失常是晚期死亡的危险因素。
森宁手术后的长期随访显示，窦房结功能障碍和右心室功能障碍的发生率随时间增加。右心室功能恶化是一个主要问题。早期识别并启动适当的治疗以保护心脏功能是重要的随访目标。
