Department of Cardiovascular Surgery, Bordeaux Heart University Hospital, University of Bordeaux II, Bordeaux, France.
Ann Thorac Surg. 2011 Dec;92(6):2206-13; discussion 2213-4. doi: 10.1016/j.athoracsur.2011.06.024. Epub 2011 Oct 1.
Risk factors and rates of reoperation, arrhythmias, systemic right ventricular dysfunction (RVD), and late death after a Senning procedure were investigated.
One-hundred thirty-two patients underwent a Senning operation between 1977 and 2004 (105 simple and 27 complex transpositions of the great arteries). Mean follow-up time was 19.5 ± 6.6 years. Surviving patients were evaluated by transthoracic echocardiography and electrocardiography. Right ventricular function was assessed in 70 patients by isotopic ventriculography or magnetic resonance imaging.
Operative and late mortality were 5.3% (7/132) and 9.6% (12/125), respectively. Nine patients were reoperated for left ventricular outflow tract obstruction or baffle stenosis. Survival rate was 91.5%, 91%, 89%, and 88% at 1, 5, 10, and 20 years, respectively. Probability of maintaining permanent sinus rhythm was 80%, 65%, 55%, and 44%. Twelve patients required pacemaker implantation. Probability of no supraventricular tachycardia, atrial flutter/fibrillation or ventricular tachycardia was 95.5%, 91.5%, 88%, and 75%, respectively. These parameters were similar for simple and complex transposition. Probability of right ventricular ejection fraction >40% was 100% at 5 and 10 years, and 98% at 20 years for simple transposition, and 100%, 92%, and 58% for complex transposition. This difference was statistically significant. Risk factors for RVD were complex transposition (p < 0.001), body weight (p = 0.008), no cardioplegia (p < 0.001), and tricuspid valve regurgitation (p = 0.004).
Senning procedure results in very good long-term survival out to 20 years. Both RVD and baffle stenosis were rare, but there was a concerning incidence of arrhythmia over time suggesting careful long-term surveillance.
研究了 Senning 手术后的再手术率、心律失常、全身右心室功能障碍 (RVD) 和晚期死亡率的危险因素。
1977 年至 2004 年间，132 例患者接受了 Senning 手术（单纯性大动脉转位 105 例，复杂性大动脉转位 27 例）。平均随访时间为 19.5 ± 6.6 年。存活患者接受了经胸超声心动图和心电图检查。70 例患者通过放射性核素心室造影或磁共振成像评估右心室功能。
手术死亡率和晚期死亡率分别为 5.3%（7/132）和 9.6%（12/125）。9 例患者因左心室流出道梗阻或隔瓣狭窄而再次手术。1、5、10 和 20 年的生存率分别为 91.5%、91%、89%和 88%。维持窦性心律的概率分别为 80%、65%、55%和 44%。12 例患者需要植入起搏器。无室上性心动过速、心房扑动/颤动或室性心动过速的概率分别为 95.5%、91.5%、88%和 75%。单纯性和复杂性大动脉转位的这些参数相似。单纯性大动脉转位的右心室射血分数>40%的概率在 5 年和 10 年时均为 100%，在 20 年时为 98%，而复杂性大动脉转位的概率分别为 100%、92%和 58%。这一差异具有统计学意义。RVD 的危险因素包括复杂性大动脉转位（p<0.001）、体重（p=0.008）、无心脏停搏（p<0.001）和三尖瓣反流（p=0.004）。
Senning 手术的长期生存率非常好，可达 20 年。尽管 RVD 和隔瓣狭窄罕见，但心律失常的发生率随着时间的推移而令人担忧，这提示需要进行仔细的长期监测。
