Koolbergen David R, Manshanden Johan S J, Yazdanbakhsh Aria P, Bouma Berto J, Blom Nico A, de Mol Bas A J M, Mulder Barbara J, Hazekamp Mark G
Department of Cardiothoracic Surgery, Academic Medical Centre, Amsterdam, Netherlands Leiden University Medical Centre, Leiden, Netherlands
Department of Cardiothoracic Surgery, Academic Medical Centre, Amsterdam, Netherlands.
Eur J Cardiothorac Surg. 2014 Sep;46(3):474-9; discussion 479. doi: 10.1093/ejcts/ezu026. Epub 2014 Feb 23.
To evaluate incidence and results of surgical intervention for neoaortic root pathology following arterial switch operation (ASO) for transposition of the great arteries (TGA).
Between April 1996 and August 2013, 12 patients underwent reoperation for neoaortic root dilatation (ARD) and/or neoaortic valve regurgitation (AR). Maximal aortic sinus and annulus diameter Z-scores were recorded. Original diagnoses were TGA/IVS (6), TGA/ventricular septal defect (VSD) (4) and Taussig-Bing anomaly (2) with ASO at a median age of 0.1 (range: 0-10.6) years. Age at ASO, VSD and complex TGA were reviewed as possible risk factors for reoperation.
Twelve patients with tricuspid neoaortic valves underwent 15 root operations; indications were root dilatation (4) and root dilatation with AR (8). Median age was 18.0 (3.0-29.0) years at first reoperation. Median aortic root Z-score at reoperation was 6.33 (range: 3.84-12.15). Procedures were: Bentall procedure (6), aortic valve replacement (2), neoaortic valve plasty (1), supracoronary tube (1) and switch-back operation (2). Mean follow-up was 7.0 ± 5.7 years and complete. No mortality occurred. One patient had two reoperations for late endocarditis. Technical difficulties were encountered related to specific anatomy post-ASO concerning coronary anatomy, poor exposure and thin-walled aorta at the site of pulmonary artery bifurcation after Lecompte manoeuvre. Valve sparing surgery seemed not feasible due to specific anatomy of the neoaortic root and valve. No risk factors for reoperation could be identified.
After ASO, surgery for neoaortic root pathology may become necessary when follow-up is long enough and regardless of primary diagnosis or other risk factors. Redo neoaortic surgery can be performed with low risk taking into account the specific technical difficulties.
评估大动脉转位（TGA）动脉调转术（ASO）后新主动脉根部病变的手术干预发生率及结果。
1996年4月至2013年8月期间，12例患者因新主动脉根部扩张（ARD）和/或新主动脉瓣反流（AR）接受再次手术。记录最大主动脉窦和瓣环直径Z值。原诊断为TGA/室间隔完整（IVS）（6例）、TGA/室间隔缺损（VSD）（4例）和陶西格-宾畸形（2例），行ASO时的中位年龄为0.1岁（范围：0 - 10.6岁）。回顾ASO、VSD和复杂TGA时的年龄，作为再次手术的可能危险因素。
12例三尖瓣型新主动脉瓣患者接受了15次根部手术；手术指征为根部扩张（4例）和根部扩张合并AR（8例）。首次再次手术时的中位年龄为18.0岁（3.0 - 29.0岁）。再次手术时主动脉根部的中位Z值为6.33（范围：3.84 - 12.15）。手术方式包括：Bentall手术（6例）、主动脉瓣置换术（2例）、新主动脉瓣成形术（1例）、冠状动脉上血管置换术（1例）和回返手术（2例）。平均随访7.0±5.7年，随访完整。无死亡病例。1例患者因晚期心内膜炎接受了两次再次手术。由于ASO术后冠状动脉解剖、暴露不佳以及Lecompte操作后肺动脉分叉处主动脉壁薄等特定解剖结构，手术遇到技术困难。由于新主动脉根部和瓣膜的特定解剖结构，保留瓣膜手术似乎不可行。未发现再次手术的危险因素。
ASO术后，当随访时间足够长时，无论原发诊断或其他危险因素如何，新主动脉根部病变的手术治疗可能是必要的。考虑到特定的技术困难，再次主动脉手术可以在低风险下进行。
