Hraska Viktor, Vergnat Mathieu, Zartner Peter, Hart Chris, Suchowerskyj Phillip, Bierbach Benjamin, Schindler Ehrenfried, Schneider Martin, Asfour Boulos
Herma Heart Center, Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
German Pediatric Cardiac Center, Sankt Augustin, Germany.
Ann Thorac Surg. 2017 Aug;104(2):650-656. doi: 10.1016/j.athoracsur.2017.04.050. Epub 2017 Jun 23.
Anatomic correction of corrected transposition of the great arteries with associated lesions, utilizing the morphologic left ventricle as a systemic pumping chamber, is the preferred method in many centers. The purpose of this study was to analyze functional outcome after anatomic correction.
Between Jan 1997 and May 2016, 63 patients with corrected transposition of the great arteries and associated lesions underwent anatomic correction. Forty-two patients (67%) underwent palliation before correction, including 14 patients (22%) who required training of systemic ventricle. The double switch procedure was performed in 37 patients; 25 patients underwent the Senning-Rastelli operation, and 1 patient underwent the Senning-Nikaidoh procedure. The median age at correction was 1.6 ± 3.7(SD) years (range, 0.2 to 17.8 years).
The survival and freedom from any event was 95% and 71%, respectively, at 15-year follow-up. The combined freedom from death, failure of systemic ventricle, or heart transplant was 93% at 15-year follow-up regardless of procedure type. Sinus rhythm was present in 49 patients, with 14 patients requiring pacemaker (22%)-8 preoperatively, 4 early postoperatively, and 2 late postoperatively. Neurological development is normal in all patients. Fifty-four percent of the patients are not on medication.
Anatomic correction of corrected transposition of the great arteries is a safe procedure that provides encouraging survival and functional benefits. Ninety-three percent preservation of morphological left ventricle function in 15 years of follow-up supports the concept of anatomic correction. Longer follow-up is needed to confirm superiority of this approach over other management strategies.
在许多中心，利用形态学上的左心室作为体循环泵血腔，对矫正型大动脉转位合并相关病变进行解剖矫正，是首选方法。本研究的目的是分析解剖矫正后的功能结局。
1997年1月至2016年5月，63例矫正型大动脉转位合并相关病变的患者接受了解剖矫正。42例患者（67%）在矫正前接受了姑息治疗，其中14例患者（22%）需要对体循环心室进行训练。37例患者进行了双调转手术；25例患者接受了森宁-拉斯泰利手术，1例患者接受了森宁-尼凯多手术。矫正时的中位年龄为1.6±3.7（标准差）岁（范围为0.2至17.8岁）。
在15年的随访中，生存率和无任何事件生存率分别为95%和71%。无论手术类型如何，在15年的随访中，联合无死亡、体循环心室功能衰竭或心脏移植的生存率为93%。49例患者为窦性心律，14例患者需要起搏器（22%）——8例术前需要，4例术后早期需要，2例术后晚期需要。所有患者神经发育均正常。54%的患者未服用药物。
矫正型大动脉转位的解剖矫正是一种安全的手术，能提供令人鼓舞的生存和功能获益。15年随访中93%的形态学左心室功能保留支持了解剖矫正的概念。需要更长时间的随访来证实这种方法优于其他治疗策略。
