Hraska V, Podnar T, Kunovsky P, Kovacikova L, Kaldararova M, Horvathova E, Masura J, Mayer J E
Department of Cardiac Surgery, Children's Hospital, Bratislava, Slovakia.
Eur J Cardiothorac Surg. 2003 Sep;24(3):352-7. doi: 10.1016/s1010-7940(03)00439-1.
To assess the results of a cooperative arrangement between Slovakia and Slovenia for neonatal cardiac surgery. The aim of the study was to analyze the performance of this approach for complete transposition of the great arteries (D-TGA).
Due to the overall small number of new patients with D-TGA in Slovenia a decision was made to avoid a prolonged learning curve by centralizing the experience of two countries at one center. Since 1995 the center in Slovakia has become the only referral center for Slovenia. Between February 1993 and June 2002 in this center, 147 patients with D-TGA underwent arterial switch operation (ASO). The median age at operation was 11 days, with 110 patients from Slovakia and 37 patients from Slovenia.
Overall hospital mortality was 4.8% (seven patients). The 1, 2, 3, 4 and 5 year survival rate was 95% with the mean follow-up of 4 years. Operation before 1997 (P=0.0001) was identified as a risk predictor for death by multivariate analysis. There are no deaths among the 90 patients operated on after 1996. All patients are without medication with normal left ventricular function. Stenosis (gradient >30 mmHg) was noted in the pulmonary artery reconstruction in seven patients (5%). More than mild aortic regurgitation was noted in five patients (4%). The incidence of redo or reintervention was 5% at 5 years of follow-up.
In the current era a prolonged learning curve for ASO is not acceptable to most European countries and their patients. The risk of surgery can be minimized by concentrating surgical experience as part of the quality control of congenital heart programs. If the number of new patients is small due to the birth rate and size of the population, institutions should merge activity. Such centralization amplifies the experience to the benefit of the patient.
评估斯洛伐克和斯洛文尼亚在新生儿心脏手术方面合作安排的成果。本研究的目的是分析这种方法用于大动脉完全转位（D-TGA）的效果。
由于斯洛文尼亚新患D-TGA的患者总数较少，因此决定通过将两国的经验集中于一个中心来避免漫长的学习曲线。自1995年以来，斯洛伐克的中心已成为斯洛文尼亚唯一的转诊中心。1993年2月至2002年6月，该中心有147例D-TGA患者接受了动脉调转手术（ASO）。手术时的中位年龄为11天，其中110例来自斯洛伐克，37例来自斯洛文尼亚。
总体医院死亡率为4.8%（7例患者）。1、2、3、4和5年生存率为95%，平均随访4年。多因素分析确定1997年前手术（P=0.0001）是死亡的风险预测因素。1996年后接受手术的90例患者中无死亡病例。所有患者无需药物治疗，左心室功能正常。7例患者（5%）的肺动脉重建中发现狭窄（压差>30 mmHg）。5例患者（4%）发现有中度以上主动脉瓣反流。随访5年时再次手术或再次干预的发生率为5%。
在当今时代，大多数欧洲国家及其患者都无法接受ASO漫长的学习曲线。通过集中手术经验作为先天性心脏病项目质量控制的一部分，可以将手术风险降至最低。如果由于出生率和人口规模导致新患者数量较少，机构应合并活动。这种集中化可积累经验，造福患者。
