Pediatric and Grown-Up Congenital Cardiac Surgery, Policlinico S.Orsola-Malpighi, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
Eur J Cardiothorac Surg. 2010 Dec;38(6):714-20. doi: 10.1016/j.ejcts.2010.03.055. Epub 2010 May 7.
To analyse the long-term patency of coronary arteries after neonatal arterial switch operation (ASO).
A retrospective study of the operative reports, follow-up and postoperative catheterisation data of 119 patients, who underwent the great arteries (TGA) repair since 1991, has been carried out.
Among the 133 survivors of the 137 ASOs performed between 1991 and 2007, 119 patients have been studied by routine control cardiac catheterisation and form the study population. Median time between repair and the coronary angiography was 2.9±1.9 years. A comparison between the eight patients (6.7% out of the entire study population), known to have postoperative coronary obstructions (group I) and the rest of the cohort with angiographic normal coronary vessels (group II) was performed by univariate analysis of variance and logistic regression models. One patient had surgical plasty of the left coronary main stem with subsequent percutaneous angioplasty, three patients had primary coronary stent implantation and four patients had no further intervention at all. In group I, all but one patient denied symptoms of chest pain and echocardiography failed to show any difference between the two groups in terms of left ventricular systolic function (ejection fraction group I 61±2% vs 62±6% of group II, p=1.0).
The association of coronary obstruction with complex native coronary anatomy (Yacoub type B to E) was evident at both univariate (62% of group I vs 22% of group II, p=0.04) and logistic regression (p=0.007, odds ratio (OR) 8.1) models. The type of coronary reimplantation (i.e., coronary buttons on punch vs trap-door techniques) was similar between the two groups (punch reimplantation in 25% of patients of group I vs 31% of group II, p=0.1) as was the relative position of the great vessels (aorta anterior in 100% of patients of group I vs 96% of group II; univariate, p=0.1).
The late outcome in terms of survival and functional status after ASO is excellent. Nevertheless, the risk of a clinically silent late coronary artery obstruction of the reimplanted coronary arteries warrants a prolonged follow-up protocol involving invasive angiographic assessment.
分析新生儿动脉调转术（ASO）后冠状动脉的长期通畅情况。
对 1991 年以来接受大动脉（TGA）修复的 137 例 ASO 手术报告、随访和术后导管插入数据进行回顾性研究。
在 1991 年至 2007 年间进行的 133 例 ASO 幸存者中，对 119 例患者进行了常规心脏导管检查，并作为研究人群。修复与冠状动脉造影之间的中位时间为 2.9±1.9 年。对 8 例（整个研究人群的 6.7%）已知术后存在冠状动脉阻塞的患者（I 组）和其余冠状动脉造影正常的患者（II 组）进行了单变量方差分析和逻辑回归模型比较。1 例患者行左冠状动脉主干外科成形术，随后行经皮血管成形术，3 例患者行原发性冠状动脉支架植入术，4 例患者未进行任何进一步治疗。I 组中，除 1 例患者外，所有患者均否认胸痛症状，且两组左心室收缩功能无差异（I 组射血分数为 61±2%，II 组为 62±6%，p=1.0）。
复杂的固有冠状动脉解剖结构（雅可比 B 至 E 型）与冠状动脉阻塞的关联在单变量（I 组 62%，II 组 22%，p=0.04）和逻辑回归（p=0.007，比值比（OR）8.1）模型中均有明显体现。两组患者的冠状动脉再植入类型（即打孔冠状动脉纽扣与活瓣技术）相似（I 组 25%，II 组 31%，p=0.1），大血管的相对位置也相似（I 组 100%，II 组 96%，p=0.1）。
ASO 后的生存和功能状态的晚期结果是极好的。然而，再植入冠状动脉的临床无症状性晚期冠状动脉阻塞的风险需要一个长期的随访方案，包括有创性血管造影评估。
