Daebritz S H, Nollert G, Sachweh J S, Engelhardt W, von Bernuth G, Messmer B J
Department of Thoracic and Cardiovascular Surgery, University Hospital RWTH, Aachen, Germany.
Ann Thorac Surg. 2000 Jun;69(6):1880-6. doi: 10.1016/s0003-4975(00)01241-8.
The arterial switch operation (ASO) is the treatment of choice for transposition of the great arteries.
Anatomical risk factors on mortality and morbidity were analyzed retrospectively in 312 patients who underwent ASO between 1982 and 1997.
Survival was 95%, 92%, and 92% after 30 days, 5, and 10 years, respectively. Operative survival improved after 1990 to 97% (p < 0.001). Risk factors for operative mortality were complex anatomy (p = 0.018), coronary anomalies (p = 0.008), and prolonged bypass time (p < 0.001). Determinants of late mortality were coronary distribution (p = 0.03), position of the great arteries (p = 0.0095), bypass time (p = 0.047), and aortic coarctation (p = 0.046). After a follow-up of 3.6 +/- 2.7 years (0.1 to 14.9 years), 98% had good left ventricle function, 94% were in sinus rhythm, 2.4% had moderate to severe pulmonary stenosis, 0.3% had significant aortic regurgitation, and 1% had coronary stenosis. Freedom from reoperation was 100%, 96%, and 94% after 1, 5, and 10 years, respectively. No preoperative anatomic parameter correlated with long-term morbidity.
ASO can be performed with low operative mortality (< 5%) and long-term morbidity. Malformations associated with complex transposition of the great arteries influence early and late mortality.
动脉调转术（ASO）是大动脉转位的首选治疗方法。
对1982年至1997年间接受ASO的312例患者的解剖学危险因素对死亡率和发病率的影响进行回顾性分析。
30天、5年和10年后的生存率分别为95%、92%和92%。1990年后手术生存率提高到97%（p<0.001）。手术死亡的危险因素包括复杂解剖结构（p = 0.018）、冠状动脉异常（p = 0.008）和体外循环时间延长（p<0.001）。晚期死亡的决定因素包括冠状动脉分布（p = 0.03）、大动脉位置（p = 0.0095）、体外循环时间（p = 0.047）和主动脉缩窄（p = 0.046）。在3.6±2.7年（0.1至14.9年）的随访后，98%的患者左心室功能良好，94%为窦性心律，2.4%有中度至重度肺动脉狭窄，0.3%有明显主动脉瓣反流，1%有冠状动脉狭窄。1年、5年和10年后再次手术的免手术率分别为100%、96%和94%。术前解剖参数与长期发病率无相关性。
ASO手术死亡率低（<5%）且长期发病率低。与复杂大动脉转位相关的畸形影响早期和晚期死亡率。
