Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Korea.
Ann Thorac Surg. 2010 Jan;89(1):159-67. doi: 10.1016/j.athoracsur.2009.08.071.
This study was undertaken to evaluate long-term results of biventricular repairs for congenitally corrected transposition of the great arteries, and to analyze the risk factors that affect mortality and morbidity.
Between 1983 and 2009, 167 patients with congenitally corrected transposition of the great arteries underwent biventricular repairs. The physiologic repairs were performed in 123 patients, and anatomic repairs in 44. Average follow-up was 9.3 +/- 6.6 years.
Kaplan-Meier estimated survival was 83.3% +/- 0.5% at 25 years in biventricular repair. In anatomic repair, left ventricular training and right ventricular dysfunction had negative impact on survival, but bidirectional cavopulmonary shunt had positive impact on survival. The reoperation-free ratio was 10.1% +/- 7.8% at 22 years after physiologic repair, and 46.2% +/- 12.4% at 15 years after anatomic repair (p = 0.885). Freedom from any arrhythmia was 49.6% +/- 7.5% at 22 years after physiologic repair, and 60.8% +/- 14.8% at 18 years after anatomic repair (p = 0.458). Freedom from systemic atrioventricular valve and ventricular dysfunction as well as tricuspid valve and right ventricular dysfunction was significantly higher in anatomic repair than in physiologic repair.
Long-term results of biventricular repair were satisfactory. Patients presenting with right ventricular dysfunction or need for left ventricular training represent a high-risk group of anatomic repair for which selection criteria are particularly important. Late functional outcomes of anatomic repair were excellent compared with physiologic repair. Anatomic repair is the procedure of choice for those patients if both ventricles are adequate or if surgical technique is modified with the help of additional a bidirectional cavopulmonary shunt.
本研究旨在评估双心室修复治疗先天性矫正型大动脉转位的长期结果，并分析影响死亡率和发病率的危险因素。
1983 年至 2009 年间，共有 167 例先天性矫正型大动脉转位患者接受了双心室修复。其中 123 例患者行生理性修复，44 例患者行解剖学修复。平均随访 9.3±6.6 年。
Kaplan-Meier 估计，25 年时双心室修复的生存率为 83.3%±0.5%。在解剖学修复中，左心室训练和右心室功能障碍对生存率有负面影响，但双向腔肺分流术对生存率有积极影响。生理性修复后 22 年的无再手术率为 10.1%±7.8%，解剖学修复后 15 年的无再手术率为 46.2%±12.4%（p=0.885）。生理性修复后 22 年无任何心律失常的比例为 49.6%±7.5%，解剖学修复后 18 年无任何心律失常的比例为 60.8%±14.8%（p=0.458）。解剖学修复的房室瓣和心室功能障碍以及三尖瓣和右心室功能障碍的无发生比例明显高于生理性修复。
双心室修复的长期结果令人满意。右心室功能障碍或需要左心室训练的患者代表解剖学修复的高危人群，因此选择标准尤为重要。与生理性修复相比，解剖学修复的晚期功能结果非常出色。如果两个心室都足够或在额外双向腔肺分流术的帮助下修改手术技术，则解剖学修复是这些患者的首选方法。
