Adachi Osamu, Masaki Naoki, Kawatsu Satoshi, Yoshioka Ichiro, Masuda Shinya, Fujiwara Hideki, Akiyama Masatoshi, Kumagai Kiichiro, Kawamoto Shunsuke, Saiki Yoshikatsu
Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryocho, Aoba-ku, Sendai, 980-8574, Japan.
Gen Thorac Cardiovasc Surg. 2016 Dec;64(12):715-721. doi: 10.1007/s11748-016-0689-1. Epub 2016 Jul 18.
We aimed to evaluate the long-term results of physiologic repair for associated lesions of congenitally corrected transposition of great arteries (ccTGA) and to provide a basis for comparison with anatomic repair for this entity.
Sixteen ccTGA patients who underwent physiologic repair from 1970 to 2000 comprise this retrospective study. Conventional Rastelli procedure was performed in 12 patients with pulmonary stenosis or atresia (PS/PA). Ventricular septal defect closure was carried out in 2 patients, atrial septal closure in 1, and tricuspid valvuloplasty in 1 without PS/PA. Mean follow-up period was 19.4 years. Long-term survival rates were assessed with respect to the presence or the absence of preoperative PS/PA and specifically in relation with the magnitude of pre- and postoperative tricuspid regurgitation (TR).
There has been no long-term mortality in the ccTGA patients without PS/PA. Twenty-year survival rate after conventional Rastelli was 71 %. Overall 20-year freedom from more than mild TR or tricuspid valve replacement was 44 %. The development of postoperative more than mild TR was significantly linked with pre-repair right ventricular enlargement (p = 0.019), but not with the magnitude of pre-repair TR (p = 0.85).
Long-term outcomes of physiologic repair for ccTGA were equivalent to those of reported anatomic repair performed in several centers during the same era. Notably, significant TR was observed in more than half of physiologically repaired patients over the 20 years after repair. The degree of pre-repair TR cannot predict the long-term function of tricuspid valve after physiologic repair.
我们旨在评估大动脉转位矫正术（ccTGA）相关病变的生理修复长期结果，并为该疾病的解剖修复提供比较依据。
本回顾性研究纳入了1970年至2000年间接受生理修复的16例ccTGA患者。12例合并肺动脉狭窄或闭锁（PS/PA）的患者接受了传统的Rastelli手术。2例患者进行了室间隔缺损闭合术，1例进行了房间隔闭合术，1例无PS/PA的患者进行了三尖瓣成形术。平均随访期为19.4年。根据术前是否存在PS/PA以及术前和术后三尖瓣反流（TR）的程度评估长期生存率。
无PS/PA的ccTGA患者无长期死亡病例。传统Rastelli术后20年生存率为71%。总体而言，20年无中度以上TR或三尖瓣置换的比例为44%。术后出现中度以上TR与修复前右心室扩大显著相关（p = 0.019），但与修复前TR的程度无关（p = 0.85）。
ccTGA生理修复的长期结果与同一时期几个中心报道的解剖修复结果相当。值得注意的是，在生理修复后的20年里，超过一半的患者出现了显著的TR。修复前TR的程度不能预测生理修复后三尖瓣的长期功能。
