Children's Hospital, Bristol, United Kingdom.
Ann Thorac Surg. 2012 Jun;93(6):1977-83. doi: 10.1016/j.athoracsur.2011.11.061. Epub 2012 Feb 23.
The arterial switch operation (ASO) has become a safe, reproducible surgical procedure with low mortality in experienced centers. We examined morbidity, which remains significant, particularly for complex ASO.
From 2003 to 2011, 101 consecutive patients underwent ASO, arbitrarily classified as "simple" (n=52) or "complex" (n=49). Morbidity was measured in selected complications and postoperative hospitalization. Three outcomes were analyzed: ventilation time, postextubation hospital length of stay, and a composite morbidity index, defined as ventilation time+postextubation hospital length of stay+occurrence of selected major complications. Complexity was measured with the comprehensive Aristotle score.
The operative mortality was zero. Twenty-five major complications occurred in 23 patients: 6 of 25 (12%) in simple ASO and 19 of 49 (39%) in complex ASO (p=0.002). The most frequent complication was unplanned reoperation (15 vs 6, p=0.03). No patients required permanent pacing. The complex group had a significantly higher morbidity index and longer ventilation time and postextubation hospital length of stay. In multivariate analysis, factors independently predicting higher morbidity were the comprehensive Aristotle score, arch repair, bypass time, and malaligned commissures. Myocardial infarction caused one sudden late death at 3 months. Late coronary failure was 2%. Overall survival was 99% at a mean follow-up of 49±27 months.
In this consecutive series without operative mortality, morbidity was significantly higher in complex ASO. The only anatomic incremental risk factors for morbidity were aortic arch repair and malaligned commissures, but not primary diagnosis, weight less than 2.5 kg, or coronary patterns.
在经验丰富的中心，动脉调转手术（ASO）已成为一种安全、可重复的手术，死亡率较低。我们检查了发病率，发病率仍然很高，尤其是对于复杂的 ASO。
从 2003 年到 2011 年，101 例连续患者接受了 ASO，任意分为“简单”（n=52）或“复杂”（n=49）。选择并发症和术后住院时间来衡量发病率。分析了三种结果：通气时间、拔管后住院时间和综合发病率指数，定义为通气时间+拔管后住院时间+选定主要并发症的发生。复杂性用综合的亚里士多德评分来衡量。
手术死亡率为零。23 例患者发生 25 例重大并发症：简单 ASO 中 6 例（12%），复杂 ASO 中 19 例（39%）（p=0.002）。最常见的并发症是计划外再次手术（15 例比 6 例，p=0.03）。无患者需要永久性起搏。复杂组的发病率指数、通气时间和拔管后住院时间明显较长。在多变量分析中，独立预测发病率较高的因素是综合亚里士多德评分、弓部修复、旁路时间和不匹配的嵴。心肌梗死导致 1 例 3 个月后突然死亡。晚期冠状动脉衰竭为 2%。在平均随访 49±27 个月后，总生存率为 99%。
在这一系列无手术死亡率的连续患者中，复杂 ASO 的发病率明显较高。发病率的唯一解剖学增量危险因素是主动脉弓部修复和不匹配的嵴，但不是原发性诊断、体重小于 2.5kg 或冠状动脉模式。
