Thompson L D, McElhinney D B, Reddy M, Petrossian E, Silverman N H, Hanley F L
Division of Cardiothoracic Surgery, University of California, San Francisco 94143-0118, USA.
Ann Thorac Surg. 2001 Aug;72(2):391-5. doi: 10.1016/s0003-4975(01)02796-5.
Repair of truncus arteriosus in the neonatal and early infant periods has become standard practice at many centers. We reviewed our recent experience with repair of truncus arteriosus in neonates, with a focus on early and intermediate outcomes.
From July 1992 to December 1999, 65 patients 1 month of age or less underwent primary complete repair of truncus arteriosus. Median age was 10 days, and median weight was 3.2 kg. Major associated anomalies included moderate or severe truncal valve regurgitation in 15 patients (23%), interrupted aortic arch in 8 (12%), coronary artery abnormalities in 12 (18%), and nonconfluence of the pulmonary arteries in 3 (5%). Median durations of cardiopulmonary bypass and cardioplegic arrest were 172 minutes and 90 minutes, respectively. Circulatory arrest was employed only in 7 patients undergoing concomitant repair of interrupted arch. Reconstruction of the right ventricular outflow tract was achieved with an aortic (n = 39) or pulmonary (n = 26) allograft valved conduit (median diameter, 12 mm). Replacement (n = 6) or repair (n = 5) of a regurgitant truncal valve was performed in 11 patients, and interrupted arch was repaired in 8.
There were three early deaths (5%). Early reoperations included reexploration for bleeding in 3 patients, emergent replacement of a pulmonary outflow conduit that failed acutely in 1 patient, and placement of a permanent pacemaker in 1. Mechanical circulatory support was required in 1 patient. During the median follow-up of 32 months, there were two deaths. The Kaplan-Meier estimate of survival was 92% at 1 year and beyond. The only demographic, diagnostic, or operative factors significantly associated with poorer survival over time were operative weight of 2.5 kg or less (p = 0.01) and truncal valve replacement (p = 0.009). Actuarial freedom from conduit replacement among early survivors was 57% at 3 years.
Repair of truncus arteriosus in the neonatal period can be performed routinely with excellent survival, even in patients with major associated abnormalities.
在许多中心，新生儿期和婴儿早期的动脉干修复已成为标准治疗方法。我们回顾了我们近期对新生儿动脉干修复的经验，重点关注早期和中期结果。
从1992年7月至1999年12月，65例1个月龄及以下的患者接受了动脉干一期完全修复。中位年龄为10天，中位体重为3.2千克。主要相关异常包括15例（23%）中度或重度动脉干瓣膜反流、8例（12%）主动脉弓中断、12例（18%）冠状动脉异常以及3例（5%）肺动脉不汇合。体外循环和心脏停搏的中位持续时间分别为172分钟和90分钟。仅7例接受同期主动脉弓中断修复的患者采用了循环阻断。右心室流出道重建采用主动脉（n = 39）或肺动脉（n = 26）带瓣同种异体管道（中位直径，12毫米）。11例患者进行了反流性动脉干瓣膜置换（n = 6）或修复（n = 5），8例患者修复了主动脉弓中断。
有3例早期死亡（5%）。早期再次手术包括3例因出血而再次探查、1例急性肺动脉流出道管道失败后紧急置换以及1例植入永久性起搏器。1例患者需要机械循环支持。在中位32个月的随访期间，有2例死亡。1年及以后的Kaplan-Meier生存估计值为92%。与随时间推移生存较差显著相关的唯一人口统计学、诊断或手术因素是手术体重2.5千克及以下（p = 0.01）和动脉干瓣膜置换（p = 0.009）。早期幸存者中3年时无需更换管道的精算自由度为57%。
即使在有主要相关异常的患者中，新生儿期动脉干修复也可常规进行，且生存率良好。
