动脉调转术后再次手术：27 年经验。
Reoperation after arterial switch: a 27-year experience.
机构信息
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA.
出版信息
Ann Thorac Surg. 2013 Jun;95(6):2105-12; discussion 2112-3. doi: 10.1016/j.athoracsur.2013.02.040. Epub 2013 Apr 22.
BACKGROUND
The long-term outcome and spectrum of reoperation after the arterial switch operation (ASO) has not been fully defined, and there are limited data in the literature. We reviewed our institutional experience with reoperation(s) after ASO.
METHODS
Between January 1984 and January 2012, 32 patients (23 male) underwent reoperation(s) after ASO. Anatomy included simple transposition of the great arteries in 14, complex transposition of the great arteries in 14, and Taussig-Bing in 4. Mean age was 6.7 ± 1.4 years at first operation and 10.8 ± 13.4 years at the second operation. Isolated pathology was present in 11 (34.3%) and multiple pathologies in 21 (65.6%). Abnormalities at first reoperation were right-sided pathology in 18 (56.3%), left-sided pathology in 10 (31%), coronary artery in 3 (9%), mitral valve in 3 (9%), residual ventricular septal defect in 4 (12.5%), and recoarctation in 2 (6.3%). It was the second reoperation in 12 and the third reoperation in 3 patients.
RESULTS
The first reoperation included pulmonary artery patch plasty in 18, aortic valve operation in 8 (4 valve replacement, 3 root replacement, and 1 repair), pulmonary valve replacement in 4, coronary artery bypass grafting in 3, and mitral valve repair in 3. Multiple reoperations occurred in 15 patients, comprising right-sided procedures (11), left-sided (2), and other (2). Pulmonary artery reconstruction occurred earlier than neoaortic intervention (5.4 ± 6.8 vs 13.8 ± 7.7 years, p < 0.001). There were 2 early deaths (6.2%); both patients had complex transposition of the great arteries and both were at early reoperation after ASO. Median follow-up was 14.5 years (maximum, 27 years). There were no late deaths. Freedom from reoperation at 1, 5, and 15 years was 88%, 78%, and 41%, respectively.
CONCLUSIONS
The most common indication for reoperation after ASO is right-sided pathology, followed by neoaortic root pathology. Late survival after ASO is excellent and risk of late reoperation is low. Life-long medical surveillance is required.
背景
动脉调转术（ASO）后的长期结果和再次手术的范围尚未完全明确，文献中的数据也很有限。我们回顾了我们机构在 ASO 后的再次手术经验。
方法
1984 年 1 月至 2012 年 1 月期间，32 名患者（23 名男性）在 ASO 后接受了再次手术。解剖包括简单大动脉转位 14 例，复杂大动脉转位 14 例，Taussig-Bing 手术 4 例。首次手术时的平均年龄为 6.7 ± 1.4 岁，第二次手术时为 10.8 ± 13.4 岁。11 例（34.3%）为单一病变，21 例（65.6%）为多种病变。首次再次手术时存在右心病变 18 例（56.3%），左心病变 10 例（31%），冠状动脉病变 3 例（9%），二尖瓣病变 3 例（9%），残余室间隔缺损 4 例（12.5%），和再狭窄 2 例（6.3%）。12 例患者进行了第二次再次手术，3 例患者进行了第三次再次手术。
结果
首次再次手术包括肺动脉补片成形术 18 例，主动脉瓣手术 8 例（4 例瓣膜置换，3 例根部置换，1 例修复），肺动脉瓣置换术 4 例，冠状动脉旁路移植术 3 例，二尖瓣修复术 3 例。15 例患者进行了多次再次手术，包括右心手术（11 例）、左心手术（2 例）和其他手术（2 例）。肺动脉重建早于新主动脉干预（5.4 ± 6.8 年 vs 13.8 ± 7.7 年，p < 0.001）。有 2 例早期死亡（6.2%）；这两名患者均患有复杂大动脉转位，且均在 ASO 后的早期再次手术。中位随访时间为 14.5 年（最长随访时间为 27 年）。无晚期死亡。1、5 和 15 年的无再次手术生存率分别为 88%、78%和 41%。
结论
ASO 后再次手术的最常见指征是右心病变，其次是新主动脉根部病变。ASO 后晚期生存率极佳，晚期再次手术风险低。需要终生医学随访。
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