Abarbanell Ginnie, Border William L, Schlosser Brian, Morrow Gemma, Kelleman Michael, Sachdeva Ritu
Department of Pediatrics, Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, Missouri, USA.
Department of Pediatrics, Division of Pediatric Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta and Sibley Heart Center Cardiology, Atlanta, Georgia, USA.
Congenit Heart Dis. 2018 May;13(3):476-482. doi: 10.1111/chd.12599. Epub 2018 Mar 9.
It is unclear whether neonates with interrupted aortic arch (IAA) and a smaller left ventricular outflow tract may have improved outcomes with a Yasui operation (ventricular outflow bypass procedure) over a primary complete repair. This study sought to identify preoperative echocardiographic parameters to differentiate which neonates may have improved outcomes with a primary vs Yasui operation.
Patient demographics, cardiac surgery type, complications, need for reoperation and/or interventional catheterization, and date of last follow-up were collected on neonates who underwent a biventricular repair for IAA from 2003 to 2014. Preoperative echocardiograms were analyzed for: IAA type, valve annulus size, aortic valve morphology, ventricular size and aortic arch anatomy.
Seventy-seven neonates underwent IAA repair between 2003 and 2013. 60 neonates had a primary repair and 17 a Yasui operation. Neonates that underwent a Yasui operation had significantly smaller mitral and aortic valves with aortic arch hypoplasia. Within the primary repair group, a decreasing aortic root z-score on univariate analysis increased the odds of reoperation by twofold [OR = 1.98, 95% CI: (1.15-3.42), P = .014]. A significant interaction between repair type and aortic root z-score was identified on multivariable analysis (P = .039), for neonates with aortic root z-scores less than -2.5, the probability of reoperation during the follow up time period [mean 4.5 years (3.3 months-10 year)] was significantly higher in the primary repair group compared to the Yasui group (64.3% vs 37.5%).
Neonates with IAA and an aortic root z-score less than -2.5 have lower odds of subsequent reoperations with a Yasui operation compared to a primary repair over the follow up period. These findings suggest a Yasui operation should be considered if the preoperative aortic root z-score is less than -2.5. Careful evaluation of these morphologic predictors on preoperative echocardiograms can be helpful in surgical planning in neonates with IAA.
对于患有主动脉弓中断（IAA）且左心室流出道较小的新生儿，与一期完全修复相比，采用安井手术（心室流出道旁路手术）是否能改善预后尚不清楚。本研究旨在确定术前超声心动图参数，以区分哪些新生儿采用一期手术与安井手术可能会有更好的预后。
收集了2003年至2014年接受IAA双心室修复的新生儿的患者人口统计学资料、心脏手术类型、并发症、再次手术和/或介入导管插入术的需求以及最后随访日期。对术前超声心动图进行分析，内容包括：IAA类型、瓣膜环大小、主动脉瓣形态、心室大小和主动脉弓解剖结构。
2003年至2013年期间，77例新生儿接受了IAA修复。60例新生儿接受了一期修复，17例接受了安井手术。接受安井手术的新生儿二尖瓣和主动脉瓣明显较小，且主动脉弓发育不全。在一期修复组中，单因素分析显示主动脉根部z评分降低会使再次手术的几率增加两倍[比值比（OR）=1.98，95%置信区间：（1.15 - 3.42），P = 0.014]。多因素分析确定了修复类型与主动脉根部z评分之间存在显著交互作用（P = 0.039），对于主动脉根部z评分小于 -2.5的新生儿，在随访期间[平均4.5年（3.3个月 - 10年）]，一期修复组再次手术的概率显著高于安井组（64.3%对37.5%）。
与一期修复相比，患有IAA且主动脉根部z评分小于 -2.5的新生儿在随访期间接受安井手术后续再次手术的几率较低。这些发现表明，如果术前主动脉根部z评分小于 -2.5，应考虑安井手术。对术前超声心动图上这些形态学预测指标进行仔细评估有助于IAA新生儿的手术规划。
