Zhang Sen, Ma Kai, Li Shoujun, Hua Zhongdong, Zhang Hao, Yan Jun, Yang Keming, Pang Kunjing, Wang Xu, Qi Lei, Chen Qiuming
National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Eur J Cardiothorac Surg. 2017 Jun 1;51(6):1058-1062. doi: 10.1093/ejcts/ezx033.
The hemi-Mustard and bidirectional Glenn (BDG) procedures combined with the Rastelli procedure have been applied to selected cases of congenitally corrected transposition of the great arteries (ccTGA) for potential benefit over the classic atrial switch procedure. The aim of this study was to analyse our experience with the hemi-Mustard, BDG and Rastelli procedures as an anatomical correction for patients with ccTGA/left ventricular outflow tract obstruction (LVOTO) with positional heart anomalies.
In this retrospective study, 31 consecutive patients with corrected transposition underwent the hemi-Mustard/BDG procedures with the Rastelli operation between 2011 and 2015. The median age was 5.4 (range: 0.75-12) years. Positional anomalies were present in all patients. Eleven patients underwent BDG initially; they then had the second-stage hemi-Mustard and Rastelli procedures; 'one-stage repair' (hemi-Mustard/BDG and the Rastelli procedures) was performed in 20 cases.
There were no in-hospital deaths, and 3 patients received a pacemaker. One patient had an atrial baffle obstruction that was observed in the early postoperative period; 7 patients had prolonged pleural effusions that developed more frequently in the one-stage repair group (7/20 vs 0/11, P = 0.033). During the mean follow-up of 3.3 years, 1 late death was noted, and no conduit replacements were required. Twenty-five (83.3%) patients are in New York Heart Association classes I and II at the latest follow-up.
Hemi-Mustard, BDG and the Rastelli procedures are technically feasible for correction of ccTGA/left ventricular outflow tract obstruction (LVOTO) and cardiac malposition. Nevertheless, postoperative pleural effusion is the most prevalent complication in the one-stage repair. Two-stage repair may reduce the risk of pleural effusion-related complications.
半Mustard手术和双向格林（BDG）手术联合Rastelli手术已应用于部分先天性矫正型大动脉转位（ccTGA）病例，相较于经典心房调转术可能具有优势。本研究旨在分析我们应用半Mustard手术、BDG手术和Rastelli手术对伴有心脏位置异常的ccTGA/左心室流出道梗阻（LVOTO）患者进行解剖矫正的经验。
在这项回顾性研究中，2011年至2015年间，31例连续的矫正型大动脉转位患者接受了半Mustard/BDG手术及Rastelli手术。中位年龄为5.4岁（范围：0.75 - 12岁）。所有患者均存在心脏位置异常。11例患者最初接受BDG手术；随后进行二期半Mustard手术和Rastelli手术；20例患者接受“一期修复”（半Mustard/BDG手术及Rastelli手术）。
无院内死亡病例，3例患者接受了起搏器植入。1例患者术后早期出现心房挡板梗阻；7例患者出现胸腔积液延长，在一期修复组中更常见（7/20 vs 0/11，P = 0.033）。在平均3.3年的随访期间，记录到1例晚期死亡，无需更换管道。在最近一次随访时，25例（83.3%）患者的心功能分级为纽约心脏协会I级和II级。
半Mustard手术、BDG手术和Rastelli手术在技术上可行，可用于矫正ccTGA/左心室流出道梗阻（LVOTO）及心脏位置异常。然而，术后胸腔积液是一期修复中最常见的并发症。二期修复可能降低与胸腔积液相关并发症的风险。
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