Shinkawa Takeshi, Jaquiss Robert D B, Imamura Michiaki
Division of Pediatric and Congenital Cardiothoracic Surgery, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR 72202, USA.
Interact Cardiovasc Thorac Surg. 2012 May;14(5):551-5. doi: 10.1093/icvts/ivr163. Epub 2012 Jan 27.
A single institutional outcome of the biventricular repair for congenital heart disease with interrupted aortic arch between 1982 and 2010 were retrospectively reviewed. There were 48 consecutive patients with a mean follow-up of 10.0 ± 7.9 years. The staged repair was applied in 27 patients, and primary complete repair was applied in 21. The actuarial survival was 79.0% at 10 years. There was a significant difference in survival between the patients operated before 2000 and after 2001 (65.2 vs. 100% at 10 years, P = 0.005), but not in survival between the staged repair and the primary complete repair (77.4 vs. 81.0% at 10 years, P = 0.793). There was no significant difference in freedom from unplanned reoperation between the staged repair and the primary complete repair (47.9 vs. 70.6% at 5 years, P = 0.249). No patients with primary complete repair had reoperation for left ventricular outflow tract obstruction, whereas five patients with staged repair did. The patients with interposition graft placement between ascending and descending aorta had significantly low freedom from reoperation for the aortic arch compared with other techniques (7.2 vs. 90.0% at 10 years, P = 0.001). In conclusion, surgical outcomes for interrupted aortic arch have been significantly improved in the last decade and the staged repair remains an effective option in selected patients.
回顾性分析了1982年至2010年间单中心对先天性心脏病合并主动脉弓中断进行双心室修复的结果。连续纳入48例患者,平均随访10.0±7.9年。27例患者采用分期修复,21例采用一期完全修复。10年时的精算生存率为79.0%。2000年前手术的患者与2001年后手术的患者在生存率上有显著差异(10年时分别为65.2%和100%,P=0.005),但分期修复和一期完全修复在生存率上无显著差异(10年时分别为77.4%和81.0%,P=0.793)。分期修复和一期完全修复在无计划再次手术的自由度上无显著差异(5年时分别为47.9%和70.6%,P=0.249)。一期完全修复的患者中无因左心室流出道梗阻而再次手术的,而分期修复的患者中有5例。与其他技术相比,在升主动脉和降主动脉之间置入移植血管的患者主动脉弓再次手术的自由度显著降低(10年时分别为7.2%和90.0%,P=0.001)。总之,在过去十年中,主动脉弓中断的手术效果有了显著改善,分期修复仍然是部分患者的有效选择。