Brown J W, Ruzmetov M, Okada Y, Vijay P, Turrentine M W
Section of Cardiothoracic Surgery, Indiana University Medical Center, 545 Barnhill Drive, EH 215, Indianapolis, IN 46202-5123, USA.
Eur J Cardiothorac Surg. 2001 Aug;20(2):221-7. doi: 10.1016/s1010-7940(01)00816-8.
Truncus arteriosus (TA) continues to be associated with significant morbidity and mortality, but there have been clinically significant improvements with early repair.
Sixty patients underwent physiological correction of TA between November 1978 and January 2000. The average age was 76 days (range, 3 days--20 months). Associated cardiac anomalies were frequently encountered, the most common being severe truncal valve regurgitation (n=7), interrupted aortic arch (n=6), coronary artery anomalies (n=6), non-confluent pulmonary arteries (n=4), and total anomalous pulmonary venous return (n=1). Truncal valve replacement was performed initially or subsequently in seven patients with severe regurgitation (mechanical prostheses in six patients and a cryopreserved aortic homograft in one patient). Right ventricle--pulmonary artery continuity was established with an aortic (n=16) or pulmonary homograft (n=32) in 48 patients, a Dacron polyester porcine valved conduit in five, a non-valved polytetrafluoroethylene (PTFE) tube in three, direct anastomosis to the right ventricle with anterior patch arterioplasty in three, and a bovine jugular venous valve conduit in one patient.
There were ten hospital deaths (17%; 70% confidence limit, 7--25%). Multivariate and univariate analyses demonstrated a relationship between hospital mortality and associated cardiac anomalies. In the 43 patients without these associated cardiac anomalies, the early survival was 91% (group I). In the 17 patients with one or more of these risk factors, the survival was 71% (group II, P=0.002). There was one late death. Twenty-three patients (46%) required reoperation for right ventricular outflow tract (RVOT) obstruction at a mean follow-up time of 59.1 months. In 23 patients, the RVOT reconstruction was performed with a PTFE monocusp, and six patients had of a variety of replacement conduits inserted. Postoperatively, there were 34 (68%) patients in New York Heart Association functional class I and 16 (32%) in class II. Twenty-eight surviving patients are reported as doing well without any medication. The freedom of reoperation in the 39 hospital survivors (group I) without risk factors was 64% at 7 years; and 36% at 10 years in the 11 patients (group II) surviving with risk factors.
Associated cardiac anomalies were risk factors for death after the repair of TA. In the absence of these associated lesions, TA can be repaired with an excellent surgical outcome in the neonatal and early infancy period.
永存动脉干（TA）仍然与显著的发病率和死亡率相关，但早期修复已带来了具有临床意义的改善。
1978年11月至2000年1月期间，60例患者接受了TA的生理矫正。平均年龄为76天（范围3天至20个月）。经常遇到相关的心脏异常，最常见的是严重的动脉干瓣膜反流（n = 7）、主动脉弓中断（n = 6）、冠状动脉异常（n = 6）、肺动静脉不连接（n = 4）和完全性肺静脉异位引流（n = 1）。7例严重反流患者最初或随后进行了动脉干瓣膜置换（6例患者使用机械瓣膜，1例患者使用冷冻保存的主动脉同种异体移植物）。48例患者通过主动脉同种异体移植物（n = 16）或肺动脉同种异体移植物（n = 32）建立右心室与肺动脉的连续性，5例患者使用涤纶聚酯带瓣猪导管，3例患者使用无瓣聚四氟乙烯（PTFE）管，3例患者通过前路补片动脉成形术直接与右心室吻合，1例患者使用牛颈静脉带瓣导管。
有10例住院死亡（17%；70%置信区间，7%至25%）。多变量和单变量分析表明住院死亡率与相关心脏异常之间存在关联。在43例无这些相关心脏异常的患者中，早期生存率为91%（I组）。在17例有一个或多个这些危险因素的患者中，生存率为71%（II组，P = 0.002）。有1例晚期死亡。23例患者（46%）在平均随访时间59.1个月时因右心室流出道（RVOT）梗阻需要再次手术。23例患者使用PTFE单瓣进行RVOT重建，6例患者插入了各种替代导管。术后，纽约心脏协会功能分级I级的患者有34例（68%），II级的患者有16例（32%）。据报告，28例存活患者无需任何药物治疗，情况良好。39例无危险因素的住院幸存者（I组）在7年时再次手术的自由度为64%；11例有危险因素的存活患者（II组）在10年时再次手术的自由度为36%。
相关心脏异常是TA修复术后死亡的危险因素。在没有这些相关病变的情况下，TA在新生儿期和婴儿早期可以通过手术获得良好的结果。
