Ahlström Love, Odermarsky Michal, Malm Torsten, Johansson Ramgren Jens, Liuba Petru
Department of Clinical Sciences Lund, Children Heart Center, Skane University Hospital, Lund University, Lund, 22185, Sweden.
Pediatr Cardiol. 2018 Dec;39(8):1620-1626. doi: 10.1007/s00246-018-1939-z. Epub 2018 Jul 12.
In transposition of the great arteries (TGA), certain coronary patterns have been associated with major adverse events early after the arterial switch operation (ASO). We sought to determine the impact of preoperative echocardiographic (ECHO) diagnosis on the intra- and postoperative morbidity. All patients with TGA born between June 2001 and June 2017 and who underwent ASO were reviewed. Data on presumed coronary anatomy (CA) preoperatively were obtained from the preoperative ECHO report. Intraoperative CA was categorized according to Yacoub classification. Major postoperative morbidity included at least one of the following: delayed sternal closure (DSC), prolonged (> 72 h) mechanical ventilation, reintubation, peritoneal dialysis (PD), ECMO, reoperation, and readmission within 30 days after surgery. 240 patients with median age of 5 days (range 1-614) and mean weight at surgery was 3.6 kg (1.8-8.4) were included. Preoperative ECHO assessment of CA was available in 228 patients. Intraoperatively, 181 patients (75%) were found to have type A, 25 patients had type B or C or intramural (B-C-IM; 10%), and 34 patients had type D or E (D-E; 14%). Patients with types B, C, and intramural coronary (B-C-IM) had increased risk for delayed sternum closure (9/25 vs. 20/181 in type A and 8/34 in type D-E; p = 0.04), peritoneal dialysis (4/25 vs. 8/181 and 1/34; p = 0.04), and ECMO (2/25 vs. 1/131 and 1/34; p = 0.02). Within the B-C-IM group, preoperative ECHO raised suspicion of type A in 13 patients (i.e., incorrect diagnosis, ID; 52%), whereas non-A CA was suspected in 12 patients (i.e., correct diagnosis, CD; 48%). With the exception of reoperation, which was seen only in the ID subgroup (4/12 vs. 0/10 in the CD subgroup; p = 0.04), the intraoperative (cardiopulmonary bypass time and cross-clamp time) and postoperative morbidity indices were comparable in both ID and CD subgroups (p > 0.1). Although there is a significant risk for early postoperative morbidity in TGA patients with single, interarterial, and intramural CA, there seems to be relatively limited influence of preoperative ECHO assessment of coronary anatomy on this morbidity burden.
在大动脉转位（TGA）中，某些冠状动脉形态与动脉调转手术（ASO）后早期的主要不良事件相关。我们试图确定术前超声心动图（ECHO）诊断对术中和术后发病率的影响。对2001年6月至2017年6月出生且接受ASO的所有TGA患者进行了回顾。术前假定冠状动脉解剖结构（CA）的数据来自术前ECHO报告。术中CA根据Yacoub分类进行归类。主要术后发病率包括以下至少一项：延迟胸骨闭合（DSC）、延长（>72小时）机械通气、再次插管、腹膜透析（PD）、体外膜肺氧合（ECMO）、再次手术以及术后30天内再次入院。纳入了240例患者，中位年龄为5天（范围1 - 614天），手术时平均体重为3.6千克（1.8 - 8.4千克）。228例患者有术前ECHO对CA的评估。术中，181例患者（75%）被发现为A型，25例患者为B型或C型或壁内型（B - C - IM；10%），34例患者为D型或E型（D - E；14%）。B型、C型和壁内冠状动脉（B - C - IM）患者延迟胸骨闭合的风险增加（B - C - IM组9/25例，A型组20/181例，D - E型组8/34例；p = 0.04），腹膜透析风险增加（4/25例 vs. 8/181例和1/34例；p = 0.04），ECMO风险增加（2/25例 vs. 1/181例和1/34例；p = 0.02）。在B - C - IM组中，术前ECHO使13例患者（即误诊，ID；52%）被怀疑为A型，而12例患者（即正确诊断，CD；48%）被怀疑为非A型CA。除了仅在ID亚组中出现的再次手术（CD亚组0/10例，ID亚组4/12例；p = 0.04）外，ID和CD亚组的术中（体外循环时间和主动脉阻断时间）和术后发病率指标具有可比性（p>0.1）。尽管单支、动脉间和壁内CA的TGA患者术后早期发病风险显著，但术前ECHO对冠状动脉解剖结构的评估对这种发病负担的影响似乎相对有限。
