Hirose Keiichi, Nishina Takeshi, Kanemitsu Naoki, Mizuno Akihiro, Yasumizu Daisuke, Yada Masashi, Onga Yohei, Yamanaka Kazuo
Department of Cardiovascular Surgery, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan,
Gen Thorac Cardiovasc Surg. 2015 Sep;63(9):496-501. doi: 10.1007/s11748-015-0550-y. Epub 2015 May 12.
The short-term outcome of physiologic repair for congenitally corrected transposition of the great arteries (ccTGA) is generally considered favorable; however, the long-term outcome is the greatest problem, especially with regard to right ventricular (RV) function and tricuspid regurgitation (TR). Although tricuspid valve replacement (TVR) appears to be a realistic choice for treating severe TR, determining the timing of TVR may be difficult.
We carried out a retrospective analysis of the long-term outcomes of physiologic repair for ccTGA focusing on patients with TVR. The study involved 23 patients after physiologic repair 10 or more years prior. There were 9 TVR cases in 5 pediatric patients (before age 18) and 4 adult patients.
There were two late deaths; however, there was no case related with cardiac events. Overall survival at 10 and 20 years were 95.5 and 90.2 %, respectively, and 7 of 8 patients after TVR were NYHA class I or II. No patient has presented postoperative complications in the form of bleeding or embolism after TVR with mechanical valve.
An analysis of the results of physiologic repair for ccTGA showed that the long-term outcome was overall favorable. To maintain RV function, early TVR may be a reasonable option, even in the management of patients during childhood.
大动脉转位矫正术（ccTGA）的短期预后通常被认为是良好的；然而，长期预后是最大的问题，尤其是在右心室（RV）功能和三尖瓣反流（TR）方面。尽管三尖瓣置换术（TVR）似乎是治疗严重TR的一个现实选择，但确定TVR的时机可能很困难。
我们对ccTGA生理修复的长期预后进行了回顾性分析，重点关注接受TVR的患者。该研究纳入了23例在10年或更早之前接受生理修复的患者。其中有5例儿科患者（18岁之前）和4例成年患者接受了9次TVR手术。
有2例晚期死亡；然而，没有与心脏事件相关的病例。10年和20年的总生存率分别为95.5%和90.2%，接受TVR后的8例患者中有7例为纽约心脏协会（NYHA）I级或II级。接受机械瓣膜TVR的患者术后均未出现出血或栓塞形式的并发症。
对ccTGA生理修复结果的分析表明，长期预后总体良好。为维持RV功能，早期TVR可能是一个合理的选择，即使是在儿童患者的管理中。
