Choi Kwang Ho, Sung Si Chan, Kim Hyungtae, Lee Hyoung Doo, Kim Geena, Ko Hoon, Byun Joung-Hee, Lee Young Seok
Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Mulgeum-eup, Yangsan, Gyeongsangnam, 50612, Republic of Korea.
Department of Pediatrics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
Pediatr Cardiol. 2019 Apr;40(4):813-819. doi: 10.1007/s00246-019-02075-6. Epub 2019 Feb 19.
Coronary reimplantation after neoaortic reconstruction (CRANR) in the arterial switch operation (ASO) allows easy selection of accurate coronary transfer sites in the distended neoaorta. However, neoaortic valve injury may occur during coronary reimplantation. We determined whether the CRANR procedure increased the incidence of aortic valve regurgitation (AR) after ASO. Between March 1994 and August 2017, 227 patients underwent ASO. Since September 2000 CRANR has been performed on 155 patients and open coronary reimplantation (OCR) on 72. Patients who had undergone aortocoronary flaps procedures (n = 13), had early or late mortality (n = 27), or lacked data (n = 11) were excluded. We enrolled and retrospectively reviewed the medical records of 176 patients who were followed up for postoperative AR: 38 underwent OCR and 138 underwent CRANR. We compared the incidences of early and late postoperative AR in both groups. We defined mild or greater AR as "significant AR." The groups did not differ in body weight at operation, great artery relationship, and coronary artery anatomy. The incidences of significant AR at discharge were 21.1% (8/38) in the OCR group and 16.6% (23/138) in the CRANR group (p = 0.53). The freedom from significant AR at 5 years was 59.9% in the OCR group and 62.4% in the CRANR group with no difference between the two groups (p = 0.73). Moderate AR occurred in one patient in the CRANR group. No surgical intervention was required for the aortic valve in either group. ASO using the CRANR technique did not increase the incidence of postoperative early and late AR.
在动脉调转术（ASO）中，新主动脉重建术后进行冠状动脉再植入（CRANR）可在扩张的新主动脉中轻松选择准确的冠状动脉移植部位。然而，冠状动脉再植入过程中可能会发生新主动脉瓣损伤。我们确定CRANR手术是否会增加ASO后主动脉瓣反流（AR）的发生率。1994年3月至2017年8月期间，227例患者接受了ASO。自2000年9月以来，155例患者接受了CRANR，72例患者接受了开放冠状动脉再植入（OCR）。接受主动脉冠状动脉瓣片手术的患者（n = 13）、有早期或晚期死亡的患者（n = 27）或缺乏数据的患者（n = 11）被排除。我们纳入并回顾了176例接受术后AR随访患者的病历：38例接受OCR，138例接受CRANR。我们比较了两组术后早期和晚期AR的发生率。我们将轻度或更严重的AR定义为“显著AR”。两组在手术时体重、大动脉关系和冠状动脉解剖结构方面无差异。出院时显著AR的发生率在OCR组为21.1%（8/38），在CRANR组为16.6%（23/138）（p = 0.53）。OCR组5年无显著AR的生存率为59.9%，CRANR组为62.4%，两组之间无差异（p = 0.73）。CRANR组有1例患者发生中度AR。两组均无需对主动脉瓣进行手术干预。采用CRANR技术的ASO并未增加术后早期和晚期AR的发生率。
