Furuya Tsubasa, Hoashi Takaya, Shimada Masatoshi, Imai Kenta, Komori Motoki, Kurosaki Kenichi, Fujimoto Kazuto, Ichikawa Hajime
Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Eur J Cardiothorac Surg. 2020 Jul 1;58(1):163-170. doi: 10.1093/ejcts/ezaa022.
The aim of this study was to reveal the serial changes in tricuspid regurgitation (TR) after anatomic repair for congenitally corrected transposition of great arteries.
Between 1995 and 2018, 48 patients underwent anatomic repair (atrial/arterial switch in 14 patients, atrial switch and Rastelli in 34 patients). The mean age and weight of the patients during anatomic repair was 33 (interquartile range 21.8-62.1) months and 12 (10.3-16.3) kg. The preoperative TR was less than mild in 15 patients (31.3%), mild-to-moderate in 29 patients (60.4%) and more-than-moderate in 4 patients (8.3%). Ebsteinoid dysplasia of the tricuspid valve (TV) was observed in 7 patients (14.6%). During the study period, no patient underwent TV surgery or bidirectional Glenn anastomosis at the time of anatomic repair.
There was 1 in-hospital death and 1 late death. The follow-up was completed by other surviving patients, with a median follow-up period of 12.1 years (5.9-18.1). The overall survival, reoperation-free survival and freedom from permanent pacemaker implantation rate at 15 years were 94.3%, 74.3% and 81.5%, respectively. The mean TR grade was 2.0 (1.0-2.6) preoperatively, 2.0 (1.0-2.0) at 1 year, 2.0 (2.0-2.0) at 5 years and 2.0 (2.0-2.0) at 10 years after anatomic repair. A Cox proportional hazards model showed that association of Ebsteinoid dysplasia of the TV, type of anatomic repair and previous pulmonary artery banding did not affect freedom from death or the more-than-moderate TR rate. There were 2 patients who underwent TV surgery after the anatomic repair for severe TR; TV repair was successfully done for 1 patient, the other required semi-closure of TV and one and one-half ventricle conversion.
TR remained subclinical or improved in the majority of patients after anatomic repair without TV repair. However, there were a few patients whose TR progressed to severe or massive, then required TV surgery after anatomic repair. Although exposure was difficult, TR was sometimes repairable following atrial switch, otherwise, one and one-half ventricle repair conversion would be the choice of treatment.
本研究旨在揭示大动脉转位矫正术后三尖瓣反流（TR）的系列变化。
1995年至2018年期间，48例患者接受了解剖修复（14例患者行心房/动脉调转术，34例患者行心房调转术及Rastelli手术）。解剖修复时患者的平均年龄和体重分别为33（四分位间距21.8 - 62.1）个月和12（10.3 - 16.3）千克。术前15例患者（31.3%）的TR小于轻度，29例患者（60.4%）为轻度至中度，4例患者（8.3%）大于中度。7例患者（14.6%）观察到三尖瓣（TV）埃布斯坦样发育异常。在研究期间，解剖修复时无患者接受TV手术或双向格林吻合术。
有1例住院死亡和1例晚期死亡。其余存活患者完成了随访，中位随访期为12.1年（5.9 - 18.1）。15年时的总体生存率、无再次手术生存率和无永久起搏器植入率分别为94.3%、74.3%和81.5%。解剖修复术前TR平均分级为2.0（1.0 - 2.6），术后1年为2.0（1.0 - 2.0），5年为2.0（2.0 - 2.0），10年为2.0（2.0 - 2.0）。Cox比例风险模型显示，TV埃布斯坦样发育异常、解剖修复类型和既往肺动脉环扎术与死亡风险或大于中度的TR发生率无关。有2例患者在解剖修复后因严重TR接受了TV手术；1例患者TV修复成功，另1例需要TV半闭合及单心室加半心室转换。
在未进行TV修复的情况下，大多数患者解剖修复术后TR仍为亚临床状态或有所改善。然而，有少数患者的TR进展为重度或大量反流，在解剖修复后需要TV手术。尽管暴露困难，但在心房调转术后TR有时可修复，否则，单心室加半心室修复转换将是治疗选择。
