Department of Pediatric and Congenital Heart Surgery, Cleveland Clinic Children's Hospital, Cleveland, Ohio 44195, USA.
Ann Thorac Surg. 2011 Nov;92(5):1747-54; discussion 1754-5. doi: 10.1016/j.athoracsur.2011.04.102. Epub 2011 Sep 22.
The purpose of this study is to review our experience with late reoperations after the arterial switch operation (ASO) and to introduce reparative solutions adapted from previous techniques.
A retrospective study was performed on 23 patients who underwent late reoperations after ASO between 1983 and 2010. Eighteen patients were from our concomitantly reported cohort of 258 ASO patients and 5 came from distant referrals.
Twenty-seven reoperations on 23 patients were performed for lesions relating to coronary arteries (9 procedures, 7 patients), the neoaortic root (12 procedures, 10 patients), and the right ventricular outflow tract (6 procedures, 6 patients). Four patients died: 1 from an exsanguinating gastric ulcer 4 years after prosthetic valve replacement; 1 from coronary occlusion one month postoperatively from an unroofed intramural left main coronary artery; and 2 after supravalvar pulmonary artery stenosis repair complicated by coexisting left ventricular dysfunction from the original ASO.
The ASO remains the treatment of choice for transposition of the great arteries and its variants. While the incidence of late reintervention is low, a subset of patients will require operations that extend the principles of myocardial revascularization, left ventricular outflow tract reconstruction, and relief of pulmonary stenosis.
本研究旨在回顾我们在动脉调转术（ASO）后晚期再次手术的经验，并介绍从先前技术中改进的修复方法。
对 1983 年至 2010 年间接受 ASO 后晚期再次手术的 23 例患者进行回顾性研究。18 例患者来自我们同时报道的 258 例 ASO 患者队列，5 例来自远处转诊。
23 例患者的 27 次手术用于治疗与冠状动脉（9 例，7 例）、新主动脉根部（12 例，10 例）和右心室流出道（6 例，6 例）相关的病变。4 例患者死亡：1 例在人造瓣膜置换后 4 年因出血性胃溃疡死亡；1 例在未覆盖的左主干冠状动脉壁内冠状动脉术后 1 个月因冠状动脉闭塞死亡；2 例在修复主肺动脉瓣上狭窄后因合并左心室功能不全死亡，这 2 例患者的左心室功能不全来自最初的 ASO。
ASO 仍然是大动脉转位及其变体的治疗选择。虽然晚期再次干预的发生率较低，但一部分患者将需要手术来延长心肌血运重建、左心室流出道重建和解除肺动脉狭窄的原则。
