Turina M I, Siebenmann R, von Segesser L, Schönbeck M, Senning A
Clinic for Cardiovascular Surgery, University Hospital Zurich, Switzerland.
Circulation. 1989 Sep;80(3 Pt 1):I162-7.
Late anatomic and functional results were evaluated in 220 consecutive survivors who underwent surgery in 1964-1984 for atrial correction of transposition of the great arteries (TGA). Actuarial survival was 87% at 10 years and 83% at 20 years and was higher in patients with simple than in those with complex TGA (92% vs. 84% at 10 years). Although 83% of simple TGA and 78% of complex TGA survivors belong to the oligosymptomatic or asymptomatic group, failure of the systemic ventricle occurred in 17 (7.7%) patients. This failure was more common in patients with complex than in those with simple TGA (12.1% vs. 4.1%, p less than 0.05); actuarial incidence of such failure was 3% at 5 years and 11% at 15 years, and it caused 10 of 25 (40%) of late deaths. Late dysrhythmias necessitating pacemaker implantation had an incidence of 9.8% at 10 years. Reoperations were performed in 20 (9.1%) patients, with 12 of 23 (52%) reoperations occurring in the first 2 years after correction. Stenosis of caval inflow (eight patients), or residual atrial or ventricular septal defects (eight patients) were the most common causes of reoperation. Systemic atrioventricular valve incompetence necessitating surgery occurred in only three patients. Atrial correction gives good late results, but late functional deterioration occurs in some patients.
对1964年至1984年间连续220例接受大动脉转位（TGA）心房矫治手术的存活患者进行了晚期解剖和功能结果评估。10年时的精算生存率为87%，20年时为83%，简单型TGA患者的生存率高于复杂型TGA患者（10年时分别为92%和84%）。尽管83%的简单型TGA和78%的复杂型TGA存活者属于轻度症状或无症状组，但仍有17例（7.7%）患者出现体循环心室功能衰竭。这种功能衰竭在复杂型TGA患者中比简单型TGA患者更常见（分别为12.1%和4.1%，p<0.05）；这种功能衰竭的精算发病率在5年时为3%，15年时为11%，且导致了25例晚期死亡中的10例（40%）。10年时需要植入起搏器的晚期心律失常发生率为9.8%。20例（9.1%）患者进行了再次手术，其中23例再次手术中有12例（52%）发生在矫治后的头2年。腔静脉流入道狭窄（8例）或残余房间隔或室间隔缺损（8例）是再次手术最常见的原因。仅3例患者出现需要手术治疗的体循环房室瓣关闭不全。心房矫治术的晚期效果良好，但部分患者会出现晚期功能恶化。
