Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China.
Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China.
Heart Lung Circ. 2020 May;29(5):772-779. doi: 10.1016/j.hlc.2019.01.019. Epub 2019 Apr 26.
The outcomes of anatomical repair for patients with congenitally corrected transposed great arteries remain unclear and the indications for different procedures are poorly understood.
From January 2005 to February 2016, consecutive corrected transposition patients who underwent anatomical repair at the current institution were enrolled in this retrospective study. Varied types of anatomical repair were individually customised.
A total of 85 patients were included. Fifty-one (51) and 35 patients presented with left ventricular outflow tract obstruction and cardiac malposition, respectively. Thirty-nine (39) patients presented with moderate-to-severe tricuspid regurgitation. Thirty-four (34), 19, and 32 patients underwent Senning arterial switch operations, Senning-Rastelli, and hemi-Mustard-Rastelli-bidirectional Glenn, respectively. Early after repair, there were five in-hospital deaths and nine re-operations. During 4.6 years (range, 0.5-10.3) of follow-up, seven late deaths were documented. Estimated overall survival rate after anatomical repair was 89.3%, 85.0%, and 85.0% at 1 year, 3 years, and 5 years, respectively. Instead of Senning-Rastelli, most (75.0%) early left ventricular dysfunctions were noted in patients who underwent Senning arterial switch procedures. However, all the late left ventricular dysfunctions were found in patients who underwent previous left ventricular retraining. In patients with left ventricular outflow tract obstruction, the hemi-Mustard-Rastelli-bidirectional Glenn shunt provided a lower early mortality (0% vs 15.8%, p = 0.047).
Favourable outcomes can be achieved for anatomical repair of corrected transposition. Left ventricular dysfunction was a significant postoperative issue. Hemi-Mustard-bidirectional Glenn-Rastelli procedure may provide benefits for patients with associated left ventricular outflow tract obstruction and cardiac malposition. Each procedure has its own advantages in varied anatomy.
先天性矫正性完全性大动脉转位患者解剖修复的结果尚不清楚，不同手术适应证的理解也较差。
从 2005 年 1 月至 2016 年 2 月，连续接受解剖修复的矫正性完全性大动脉转位患者在本机构进行了回顾性研究。各种类型的解剖修复都是个体化定制的。
共纳入 85 例患者。51 例和 35 例患者分别有左心室流出道梗阻和心脏位置异常。39 例患者有中度至重度三尖瓣反流。34 例、19 例和 32 例患者分别接受了 Senning 动脉转换术、Senning-Rastelli 术、半Mustard-Rastelli 双向 Glenn 术。修复后早期有 5 例院内死亡和 9 例再次手术。在 4.6 年（0.5-10.3 年）的随访期间，有 7 例晚期死亡。解剖修复后总生存率分别为 89.3%、85.0%和 85.0%，1 年、3 年和 5 年时。在接受 Senning 动脉转换术的患者中，大多数（75.0%）早期左心室功能不全的患者而不是 Senning-Rastelli 患者。然而，所有晚期左心室功能不全的患者都有左心室再训练史。在左心室流出道梗阻患者中，半Mustard 双向 Glenn 分流术可降低早期死亡率（0%对 15.8%，p=0.047）。
矫正性完全性大动脉转位的解剖修复可获得良好的结果。左心室功能障碍是术后的一个重要问题。伴左心室流出道梗阻和心脏位置异常的患者，半Mustard 双向 Glenn-Rastelli 手术可能有益。每种手术在不同的解剖结构中都有各自的优势。
