Santens Béatrice, Van De Bruaene Alexander, De Meester Pieter, Gewillig Marc, Troost Els, Claus Piet, Bogaert Jan, Budts Werner
Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium.
Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium; Department of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium.
Int J Cardiol. 2020 Oct 1;316:94-100. doi: 10.1016/j.ijcard.2020.04.072. Epub 2020 Apr 26.
Arterial switch operation (ASO) is today the first-choice surgical treatment for patients with transposition of the great arteries. Long-term outcome data still remain scarce. Moreover, the course of these patients is not uneventful. Therefore, we wanted to evaluate long-term outcome and determine on which variables to focus during follow-up.
Clinical records of 318 patients who underwent ASO between October 1981 and July 2018 were reviewed. Perioperative, post-operative, and interventional data were collected to determine mortality and the need for re-intervention. Descriptive statistics and Kaplan-Meier survival analysis were performed.
Mean follow-up time was 11.1 SD 8.5 years (range 0-35) with a mean age of 12.5 SD 9.0 years (range 0-37) at latest follow-up. In-hospital mortality was 7.5% and overall survival 90.9% for a maximum follow-up time of 35 years. Causes of early mortality were cardiogenic shock, severe pulmonary hypertension, septic shock and multiple organ failure. Causes of late mortality were cardiogenic shock, severe pulmonary hypertension, pacemaker lead fracture and fire death. Re-intervention free survival at 5-year was 91.6%, at 10-year 90.7%, at 20-year 79.2%. For all survivors, the most frequent sequelae after ASO were pulmonary artery stenosis (80.9%), of which 13.5% needed an intervention. The threshold for intervening on lesions at the level of the pulmonary artery bifurcation was higher and the percutaneous re-intervention rate was higher for non-bifurcation lesions.
Despite a relatively high peri-operative mortality, TGA patients have an excellent overall long-term survival. However, a large proportion of patients requires re-interventions, mainly for pulmonary artery stenosis.
动脉调转术（ASO）如今是大动脉转位患者的首选外科治疗方法。长期预后数据仍然匮乏。此外，这些患者的病程并非一帆风顺。因此，我们希望评估长期预后，并确定随访期间应关注哪些变量。
回顾了1981年10月至2018年7月期间接受ASO的318例患者的临床记录。收集围手术期、术后和介入治疗数据，以确定死亡率和再次干预的必要性。进行了描述性统计和Kaplan-Meier生存分析。
平均随访时间为11.1±8.5年（范围0 - 35年），最新随访时的平均年龄为12.5±9.0岁（范围0 - 37岁）。最大随访时间为35年时，住院死亡率为7.5%，总生存率为90.9%。早期死亡原因有心源性休克、严重肺动脉高压、感染性休克和多器官功能衰竭。晚期死亡原因有心源性休克、严重肺动脉高压、起搏器导线断裂和火灾死亡。5年无再次干预生存率为91.6%，10年为90.7%，20年为79.2%。对于所有幸存者，ASO后最常见的后遗症是肺动脉狭窄（80.9%），其中13.5%需要干预。肺动脉分叉处病变的干预阈值较高，非分叉处病变的经皮再次干预率较高。
尽管围手术期死亡率相对较高，但大动脉转位患者的总体长期生存率良好。然而，很大一部分患者需要再次干预，主要是因为肺动脉狭窄。
