Manso Paulo H, Amaral Fernando T V, Júnior Tarcísio J S, Jurca Mauro C, Haddad Jorge, Vicente Walter V A, Sgarbieri Ricardo N, Carmona Fabio
Department of Pediatrics, Hospital of Ribeirao Preto Medical School, University of Sao Paulo, Avenida dos Bandeirantes 3900, Ribeirão Preto, SP, 14049900, Brazil.
Department of Internal Medicine, Hospital of Ribeirao Preto Medical School, University of Sao Paulo, Avenida dos Bandeirantes 3900, Ribeirão Preto, SP, 14049900, Brazil.
Pediatr Cardiol. 2015 Dec;36(8):1657-61. doi: 10.1007/s00246-015-1213-6. Epub 2015 Jun 3.
The objective of this paper was to describe the outcomes in patients submitted to arterial switch operation and to analyze the predictors of in-hospital mortality and further need of re-operation at a single-center institution. Between September 1995 and January 2014, 128 consecutive arterial switch operations were performed. Surgical mortality during this period was analyzed retrospectively, and a follow-up analysis of the survivors was conducted. Surgical era, cardiopulmonary bypass time (p = 0.001), and diagnosis category (p = 0.025) influenced in-hospital mortality. The estimated overall survival for the 91 hospital survivors was 96.8, 96.4, and 96.2 % at 5, 10, and 15 years, respectively. The median follow-up time was 67 months (range 0.71-222 months). Three patients (5 %) presented severe aortic regurgitation. Right ventricle outflow tract systolic gradient by echocardiography was above 60 mmHg in 2 %. Late re-interventions occurred in 12 (13 %) patients with mean time of 64 ± 34 months after the initial procedure. Actuarial freedom from re-interventions at 5, 10, and 15 years was 96.4, 69.7, and 61.9 %, respectively. Arterial switch operation remains the procedure of choice in patients with transposition of great arteries. It can be performed even in middle-volume institutions, leading to the same middle- and long-term outcomes of high-volume institutions. Early high mortality rate may occur due not only to learning curve, but also to cardiopulmonary bypass time and ventricular septal defect closure.
本文的目的是描述接受动脉调转术患者的治疗结果，并分析在单一中心机构中住院死亡率及再次手术需求的预测因素。1995年9月至2014年1月期间，连续进行了128例动脉调转术。对这一时期的手术死亡率进行回顾性分析，并对幸存者进行随访分析。手术时代、体外循环时间（p = 0.001）和诊断类别（p = 0.025）影响住院死亡率。91例住院幸存者在5年、10年和15年的估计总生存率分别为96.8%、96.4%和96.2%。中位随访时间为67个月（范围0.71 - 222个月）。3例患者（5%）出现严重主动脉瓣反流。2%的患者经超声心动图检查右心室流出道收缩期梯度高于60 mmHg。12例（13%）患者发生晚期再次干预，平均时间为初次手术后64±34个月。5年、10年和15年无再次干预的精算自由度分别为96.4%、69.7%和61.9%。动脉调转术仍然是大动脉转位患者的首选术式。即使在中等规模的机构中也可以进行，能取得与大规模机构相同的中长期治疗效果。早期高死亡率可能不仅由于学习曲线，还与体外循环时间和室间隔缺损闭合有关。
