Duncan Brian W, Mee Roger B B, Mesia C Igor, Qureshi Athar, Rosenthal Geoffrey L, Seshadri Shivaprakash G, Lane Geoffrey K, Latson Larry A
Pediatric and Congenital Heart Surgery, The Children's Hospital at The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA.
Eur J Cardiothorac Surg. 2003 Jul;24(1):11-9; discussion 19-20. doi: 10.1016/s1010-7940(03)00189-1.
To determine the outcomes for a program that utilizes the double switch operation as the primary approach for congenitally corrected transposition.
The records of 46 consecutive patients from a single institution who had undergone a double switch operation from October 1993 to March 2002 were reviewed. The records of 24 patients who were evaluated during the same period and felt not to be candidates for the double switch operation or who are awaiting double switch after pulmonary artery banding were also reviewed.
The median age at operation was 28 months (range 2 months to 16.3 years). Associated defects included ventricular septal defect 40, pulmonic stenosis 13 and pulmonary atresia 16. Twenty-six patients underwent an arterial switch operation combined with a Senning procedure while 20 patients underwent combined Rastelli and Senning procedures. Before the double switch, 12 patients had required pulmonary artery banding and 21 patients had systemic to pulmonary artery shunts. The median duration of stay in the intensive care unit was 3.5 days (range 2-60 days) and the median duration of total hospital stay was 8 days (range 5-60 days). There were no hospital deaths; one patient died 5 months after discharge due to an arrhythmogenic cardiac arrest during a median follow-up of 24 months [long-term survival 98% (95% CI 89-100%)].
The double switch operation may be performed with excellent hospital and long-term survival. The theoretical advantages of this procedure which enables the morphologic left ventricle and mitral valve to support a systemic pressure load must be established by careful follow-up of these patients.
确定采用双调转手术作为先天性矫正型大动脉转位主要治疗方法的治疗效果。
回顾了1993年10月至2002年3月期间在同一机构接受双调转手术的46例连续患者的病历。还回顾了同期评估的24例患者的病历，这些患者被认为不适合进行双调转手术或在肺动脉环扎术后等待双调转手术。
手术时的中位年龄为28个月（范围2个月至16.3岁）。相关缺陷包括室间隔缺损40例、肺动脉狭窄13例和肺动脉闭锁16例。26例患者接受了动脉调转手术联合森宁手术，20例患者接受了联合拉斯泰利手术和森宁手术。在进行双调转手术前，12例患者需要进行肺动脉环扎术，21例患者进行了体肺分流术。在重症监护病房的中位住院时间为3.5天（范围2 - 60天），总住院时间的中位值为8天（范围5 - 60天）。无院内死亡；1例患者在出院后5个月因心律失常性心脏骤停死亡，中位随访时间为24个月[长期生存率98%（95%可信区间89 - 100%）]。
双调转手术可取得良好的院内生存率和长期生存率。该手术能使形态学左心室和二尖瓣承受体循环压力负荷，其理论优势必须通过对这些患者的密切随访来确立。
