Hörer J, Herrmann F, Schreiber C, Cleuziou J, Prodan Z, Vogt M, Holper K, Lange R
Department of Cardiovascular Surgery, German Heart Center Munich at the Technical University, Munich, Germany.
Thorac Cardiovasc Surg. 2007 Sep;55(6):359-64. doi: 10.1055/s-2007-964847.
Right heart failure and baffle complications may affect the health status of patients with transposition of the great arteries after an atrial switch operation.
This study aims to identify risk factors for late death, the incidence of reoperations, and the functional status of 88 patients who underwent a Mustard operation with a mean follow-up of 20.9 +/- 10.0 years.
There were 7 early and 19 late deaths. Follow-up was complete for 97 % of the hospital survivors. Survival and freedom from reoperation of the hospital survivors at 20 years was 83.7 +/- 4.2 %, and 70.6 +/- 5.4 %, respectively. Seven reoperations were performed for systemic ventricular failure, and 24 for baffle complications, with no operative mortality. Presence of a ventricular septal defect at the time of the Mustard operation was predictive for late death in multivariate analysis ( P = 0.040). At follow-up, 82 % of the patients were able to work full-time, 11 % part-time, and 7 % experienced noticeable limitations of their activities.
Presence of a VSD at the time of the Mustard operation defines a distinct subgroup with an increased risk for late death. Long-term survivors were in a good functional status but had to be reoperated frequently due to baffle complications that seemed to increase in adulthood.
右心衰竭和心房内板障并发症可能会影响大动脉转位心房调转术后患者的健康状况。
本研究旨在确定88例接受Mustard手术患者的晚期死亡危险因素、再次手术发生率及功能状态，这些患者平均随访时间为20.9±10.0年。
有7例早期死亡和19例晚期死亡。97%的住院幸存者完成了随访。住院幸存者20年时的生存率和免于再次手术率分别为83.7±4.2%和70.6±5.4%。7例因体循环心室衰竭进行了再次手术，24例因板障并发症进行了再次手术，均无手术死亡。在多因素分析中，Mustard手术时存在室间隔缺损是晚期死亡的预测因素（P = 0.040）。随访时，82%的患者能够全职工作，11%兼职工作，7%的患者活动明显受限。
Mustard手术时存在室间隔缺损定义了一个晚期死亡风险增加的独特亚组。长期幸存者功能状态良好，但由于成年期似乎增加的板障并发症，不得不频繁接受再次手术。
