Griselli Massimo, McGuirk Simon P, Stümper Oliver, Clarke Andrew J B, Miller Paul, Dhillon Rami, Wright John G C, de Giovanni Joseph V, Barron David J, Brawn William J
Department of Pediatric Cardiac Surgery, Diana, Princess of Wales Children's Hospital, Birmingham, United Kingdom.
J Thorac Cardiovasc Surg. 2006 Feb;131(2):418-26. doi: 10.1016/j.jtcvs.2005.08.066. Epub 2006 Jan 18.
The study objective was to identify how the evolution of surgical strategies influenced the outcome after the Norwood procedure.
From 1992 to 2004, 367 patients underwent the Norwood procedure (median age, 4 days). Three surgical strategies were identified on the basis of arch reconstruction and source of pulmonary blood flow. The arch was refashioned without extra material in group A (n = 148). The arch was reconstructed with a pulmonary artery homograft patch in groups B (n = 145) and C (n = 74). Pulmonary blood flow was supplied by a modified Blalock-Taussig shunt in groups A and B. Pulmonary blood flow was supplied by a right ventricle to pulmonary artery conduit in group C. Early mortality, actuarial survival, and freedom from arch reintervention or pulmonary artery patch augmentation were analyzed.
Early mortality was 28% (n = 102). Actuarial survival was 62% +/- 3% at 6 months. Early mortality was lower in group C (15%) than group A (31%) or group B (31%; P <.05). Actuarial survival at 6 months was better in group C (78% +/- 5%) than group A (59% +/- 5%) or group B (58% +/- 4%; P <.05). Fifty-three patients (14%) had arch reintervention. Freedom from arch reintervention was 76% +/- 3% at 1 year, with univariable analysis showing no difference among groups A, B, and C (P =.71). One hundred patients (27%) required subsequent pulmonary artery patch augmentation. Freedom from patch augmentation was 61% +/- 3% at 1 year, and was lower in group C (3% +/- 3%) than group A (80% +/- 4%) or group B (72% +/- 5%; P <.05).
Survival after the Norwood procedure improved after the introduction of a right ventricle to pulmonary artery conduit, but a greater proportion of patients required subsequent pulmonary artery patch augmentation. The type of arch reconstruction did not affect the incidence of arch reintervention.
本研究旨在确定手术策略的演变如何影响诺伍德手术的术后结果。
1992年至2004年，367例患者接受了诺伍德手术（中位年龄4天）。根据主动脉弓重建和肺血流来源确定了三种手术策略。A组（n = 148）在不使用额外材料的情况下重塑主动脉弓。B组（n = 145）和C组（n = 74）使用肺动脉同种异体移植补片重建主动脉弓。A组和B组通过改良的布莱洛克-陶西格分流术供应肺血流。C组通过右心室至肺动脉管道供应肺血流。分析早期死亡率、精算生存率以及免于主动脉弓再次干预或肺动脉补片扩大的情况。
早期死亡率为28%（n = 102）。6个月时的精算生存率为62%±3%。C组的早期死亡率（15%）低于A组（31%）或B组（31%；P <.05）。C组6个月时的精算生存率（78%±5%）高于A组（59%±5%）或B组（58%±4%；P <.05）。53例患者（14%）接受了主动脉弓再次干预。1年时免于主动脉弓再次干预的比例为76%±3%，单因素分析显示A组、B组和C组之间无差异（P =.71）。100例患者（27%）需要随后进行肺动脉补片扩大。1年时免于补片扩大的比例为61%±3%，C组（3%±3%）低于A组（80%±4%）或B组（72%±5%；P <.05）。
引入右心室至肺动脉管道后，诺伍德手术后的生存率有所提高，但更多患者需要随后进行肺动脉补片扩大。主动脉弓重建的类型不影响主动脉弓再次干预的发生率。
