Lee Jeong Ryul, Lim Hong Gook, Kim Yong Jin, Rho Joon Ryang, Bae Eun Jung, Noh Chung Il, Yun Yong Soo, Ahn Curie
Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul National University Medical Research Center, Jongro-gu, Seoul 110-744, South Korea.
Eur J Cardiothorac Surg. 2004 May;25(5):735-41. doi: 10.1016/j.ejcts.2004.01.001.
This study was undertaken to compare the outcomes of the Lecompte procedure and Rastelli repair in the transposition of the great arteries (TGA) with ventricular septal defect (VSD) and left ventricular outflow tract obstruction (LVOTO) and to determine the risk factors associated with unfavorable events.
Over a 12-year period (April 1990-October 2002), 35 patients underwent complete repair for TGA, VSD, and LVOTO. Twenty-five patients (71%) underwent the Lecompte modification, and mean age and weight were 23.4+/-18.2 months and 10.2+/-3.0 kg. Ten patients (29%) underwent the Rastelli operation, and mean age and weight were 39.1+/-36.1 months and 13.8+/-6.8 kg.
One early death (3%) occurred after the Lecompte procedure and no late death. The mean follow-up was 5.9+/-3.8 years. Eight patients in the Rastelli group (80%) underwent a late reoperation for obstruction of the extracardiac conduit, and in four of these patients, a reoperation for LVOTO was concomitantly required. Reoperation was also required in six patients of the Lecompte group (25%); five for right ventricular outflow tract obstruction (RVOTO) including one for LVOTO and two for VSD leakage, and one for mitral regurgitation and left pulmonary artery stenosis. The interval prior to reoperation ranged from 1.6 to 11.1 years, with a mean of 5.7+/-3.1 years. The actuarial figures for freedom from reoperation at 5 and 10 years were 40.0+/-15.5 and 26.7+/-15.0% after the Rastelli operation and 95.7+/-4.3 and 63.5+/-12.6% after the Lecompte procedure (P = 0.02). Multivariate analysis by Cox regression analysis revealed that the risk factors of RVOTO were a younger age at operation, the Rastelli operation, and ductus ligation during the operation.
The Lecompte procedure and Rastelli repair provide satisfactory early and late results. However, substantial late morbidity is more associated with conduit obstruction, and LVOTO in Rastelli repair rather than Lecompte procedure.
本研究旨在比较大动脉转位（TGA）合并室间隔缺损（VSD）及左心室流出道梗阻（LVOTO）患者行Lecompte手术与Rastelli修复术的疗效，并确定与不良事件相关的危险因素。
在12年期间（1990年4月至2002年10月），35例患者接受了TGA、VSD和LVOTO的完全修复。25例患者（71%）接受了Lecompte改良术，平均年龄和体重分别为23.4±18.2个月和10.2±3.0kg。10例患者（29%）接受了Rastelli手术，平均年龄和体重分别为39.1±36.1个月和13.8±6.8kg。
Lecompte手术后发生1例早期死亡（3%），无晚期死亡。平均随访时间为5.9±3.8年。Rastelli组8例患者（80%）因心外管道梗阻接受了晚期再次手术，其中4例患者同时需要因LVOTO进行再次手术。Lecompte组6例患者（25%）也需要再次手术；5例因右心室流出道梗阻（RVOTO），包括1例因LVOTO和2例因VSD渗漏，1例因二尖瓣反流和左肺动脉狭窄。再次手术前的间隔时间为1.6至11.1年，平均为5.7±3.1年。Rastelli手术后5年和10年无再次手术的精算数据分别为40.0±15.5%和26.7±15.0%，Lecompte手术后分别为95.7±4.3%和63.5±12.6%（P=0.02）。Cox回归分析的多因素分析显示，RVOTO的危险因素为手术时年龄较小、Rastelli手术以及手术期间结扎动脉导管。
Lecompte手术和Rastelli修复术可提供满意的早期和晚期结果。然而，晚期严重并发症更多与Rastelli修复术中的心外管道梗阻和LVOTO相关，而非Lecompte手术。
