Hsu Kang-Hong, Chang Chung-I, Huang Shu-Chien, Chen Yih-Sharng, Chiu Ing-Sh
Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan.
Division of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
Eur J Cardiothorac Surg. 2016 Feb;49(2):522-7. doi: 10.1093/ejcts/ezv148. Epub 2015 Apr 15.
We report our surgical experience in congenitally corrected transposition of great arteries (CCTGAs) and the long-term follow-up result.
From January 1995 to February 2012, 56 patients with CCTGA received definite surgical repair; 15 patients received conventional repair (Group I), 18 patients received anatomical repair (Group II) and 23 patients received single ventricular palliation (Group III). They were followed for early and late mortality, long-term survival, postoperative morbidity and reintervention or reoperation.
The overall survival rate was 80% at 16 years in Group I, 53% at 13 years in Group II and 100% at 13 years in Group III. After excluding the early surgical mortality, the long-term survival rate was 92% at 16 years in Group I, 64% at 13 years in Group II and 100% at 13 years in Group III. Patients with significant tricuspid valve regurgitation showed the worst outcome after surgery.
Our series showed good results with single ventricular palliation (SVP) in CCTGA with complex anatomy, but the long-term result should be followed. Anatomical repair is the choice of operation only for those with favourable anatomy. The more complicated intracardiac repair may result in late left ventricular outflow tract obstruction, various degrees of atrioventricular block, systemic or pulmonary venous return obstruction and the lack of an ideal conduit (e.g. homograft) for Rastelli reconstruction. Therefore, we preferred SVP in patients with complex and unfavourable anatomy.
我们报告在先天性矫正型大动脉转位（CCTGA）方面的手术经验及长期随访结果。
1995年1月至2012年2月，56例CCTGA患者接受了确定性手术修复；15例患者接受传统修复（I组），18例患者接受解剖修复（II组），23例患者接受单心室姑息治疗（III组）。对他们进行早期和晚期死亡率、长期生存率、术后发病率以及再次干预或再次手术情况的随访。
I组16年时总体生存率为80%，II组13年时为53%，III组13年时为100%。排除早期手术死亡后，I组16年时长期生存率为92%，II组13年时为64%，III组13年时为100%。三尖瓣重度反流患者术后结果最差。
我们的系列研究显示，对于解剖结构复杂的CCTGA患者，单心室姑息治疗（SVP）效果良好，但应随访长期结果。解剖修复仅适用于解剖结构有利的患者。更为复杂的心内修复可能导致晚期左心室流出道梗阻、不同程度的房室传导阻滞、体循环或肺静脉回流梗阻以及缺乏用于Rastelli重建的理想管道（如同种异体移植物）。因此，对于解剖结构复杂且不利的患者，我们更倾向于采用SVP。
