Koh Masahiro, Yagihara Toshikatsu, Uemura Hideki, Kagisaki Koji, Hagino Ikuo, Ishizaka Toru, Kitamura Soichiro
Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
Ann Thorac Surg. 2006 Feb;81(2):671-7; discussion 677. doi: 10.1016/j.athoracsur.2005.08.014.
Since 1987, anatomic biventricular repair using the double-switch operations has been our principal choice for patients with atrioventricular discordance. These alternative procedures have the theoretical advantage of using the anatomic left ventricle to support the systemic circulation.
A total of 45 patients underwent the double-switch operation. Their ages ranged from 6 months to 21 years. Associated malformations included pulmonary atresia in 27, pulmonary stenosis in 11, and Ebstein's malformation in 5. An atrial switch plus an arterial switch procedure was performed in 7, and an atrial switch plus a Rastelli-type ventriculoarterial switch procedure in 38. Follow-up ranged from 6 months to 15 years.
Early mortality was 8.9% (n = 4). In the latter half of the series (n = 23, since 1994), there was no early death. Six patients died late. Actuarial survival at 5 and 10 years was 83.6% and 77.6%, respectively. Six patients required conduit replacement, and 2 required revision of an intraatrial baffle for pulmonary venous channel obstruction and infection, respectively. Freedom from reoperation was 95.3% at 5 years and 76.2% at 10 years. Freedom from arrhythmia was 88.8% at 5 years and 78.4% at 10 years. The systemic ventricular ejection fraction was 0.568 +/- 0.103 at 1 year (n = 39), 0.555 +/- 0.105 at 5 years (n = 17), and 0.539 +/- 0.098 at 10 years (n = 12).
The surgical results of the double-switch operations have been improving. Intermediate follow-up suggests that these alternative procedures are a reasonable option for patients with atrioventricular discordance.
自1987年以来，双调转手术这种解剖学上的双心室修复术一直是我们治疗房室不一致患者的主要选择。这些替代手术在理论上具有利用解剖学左心室来支持体循环的优势。
共有45例患者接受了双调转手术。他们的年龄从6个月至21岁不等。相关畸形包括27例肺动脉闭锁、11例肺动脉狭窄和5例埃布斯坦畸形。7例患者接受了心房调转加动脉调转手术，38例患者接受了心房调转加拉斯特利型心室动脉调转手术。随访时间为6个月至15年。
早期死亡率为8.9%（n = 4）。在该系列的后半期（n = 23，自1994年起），无早期死亡病例。6例患者晚期死亡。5年和10年的精算生存率分别为83.6%和77.6%。6例患者需要更换管道，2例患者分别因肺静脉通道梗阻和感染需要对心房内挡板进行修复。5年和10年再次手术的自由度分别为95.3%和76.2%。5年和10年无心律失常的自由度分别为88.8%和78.4%。1年时（n = 39）体心室射血分数为0.568±0.103，5年时（n = 17）为0.555±0.105，10年时（n = 12）为0.539±0.098。
双调转手术的外科治疗结果一直在改善。中期随访表明，这些替代手术对于房室不一致的患者是一个合理的选择。
