Department of Pediatric Cardiology, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden.
Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Cardiac Surgery, Skåne University Hospital, Lund, Sweden.
Ann Thorac Surg. 2019 Oct;108(4):1242-1247. doi: 10.1016/j.athoracsur.2019.04.033. Epub 2019 May 29.
Transposition of the great arteries (TGA) is a complex congenital heart disease that requires early diagnosis as well as advanced surgical repair and postoperative support. This study sought to investigate the impact of surgical timing on early postoperative morbidity.
This study reviewed all patients with TGA repaired at a single institution (Skåne University Hospital, Lund, Sweden) by arterial switch operation (ASO) between June 2001 and June 2017. Major postoperative morbidity (MPM) and death within 30 days after ASOs were documented. Patients with double-outlet right ventricle, chromosomal abnormalities, and noncardiac diseases were excluded. MPM was defined as the presence of at least 1 of the following: delayed sternum closure, reoperation, prolonged mechanical ventilation, noninvasive ventilation after extubation, peritoneal dialysis, extracorporeal membrane oxygenation, and readmission.
A total of 241 patients were included, with medians for birth weight, gestational week, and age at surgery of 3.5 kg, 39 weeks, and 5 days, respectively. MPM was encountered in 32.3% of patients. Prematurity (P = .001) and need for aortic arch repair at the time of ASO (P = .04) were associated with a significant increase in MPM. Non-A coronary anatomy, associated ventricular septal defect requiring surgical closure, and fetal diagnosis of TGA had no significant impact on MPM (P = .35, .08, and .21, respectively). There was no significant difference in MPM among the surgical groups (P = .49).
Early complications after ASO do occur and are mostly associated with prematurity and the need for aortic arch repair. Timing of surgical repair does not seem to influence the rate of these complications.
大动脉转位（TGA）是一种复杂的先天性心脏病，需要早期诊断以及先进的手术修复和术后支持。本研究旨在探讨手术时机对术后早期发病率的影响。
本研究回顾了 2001 年 6 月至 2017 年 6 月期间在瑞典隆德斯卡尼大学医院通过动脉调转手术（ASO）修复的所有 TGA 患者。记录术后 30 天内的主要术后发病率（MPM）和死亡。排除具有双出口右心室、染色体异常和非心脏疾病的患者。MPM 定义为存在以下至少 1 种情况：延迟胸骨闭合、再次手术、机械通气延长、拔管后无创通气、腹膜透析、体外膜氧合和再次入院。
共纳入 241 例患者，出生体重、胎龄和手术时年龄的中位数分别为 3.5kg、39 周和 5 天。32.3%的患者发生 MPM。早产（P =.001）和 ASO 时需要主动脉弓修复（P =.04）与 MPM 显著增加相关。非 A 冠状动脉解剖、需要手术闭合的合并室间隔缺损以及 TGA 的胎儿诊断对 MPM 无显著影响（P =.35、.08 和.21）。各组间 MPM 无显著差异（P =.49）。
ASO 后早期并发症确实存在，主要与早产和主动脉弓修复的需要有关。手术修复的时机似乎并不影响这些并发症的发生率。
