Daoud Zied, Nuri Halkawt Ali, Miette Ambra, Pomè Giuseppe
Istituto Giannina Gaslini Istituto Pediatrico di Ricovero e Cura a Carattere Scientifico, Cardiovascular Surgery, Genova, Liguria, Italy.
Cardiol Young. 2020 Jul;30(7):1012-1017. doi: 10.1017/S1047951120001456. Epub 2020 Jun 29.
Prognosis of the transposition of the great arteries has completely changed since the introduction of the arterial switch. Time limit to perform this intervention is still controversial. The aim of this study is to demonstrate the early and late outcome of primary arterial switch operation beyond the age of months.
We included all patients with the diagnosis of transposition of the great arteries with intact ventricular septum beyond the age of 8 weeks who underwent primary arterial switch operation. The procedures were performed by the same surgeon, in two different institutes. Patients who had transposition of the great arteries and associated anomalies (except atrial septal defect and persistent arterial duct) were excluded. Ventricular shape, geometry, and mass were not considered during the decision on procedure type.
In the study, 11 patients with the diagnosis of simple d-transposition of the great arteries beyond 8 weeks were undergone primary arterial switch operation with a mean age of 90.63 days (60-137 days), and 7 patients had a Rashkind procedure. All patients had squashed left ventricle shape with preserved function. The sternum was left open in 10 patients. Extracorporeal membrane oxygenation support was necessary in 45.45% of cases. The mean mechanical ventilation time was 7.27 days (1-16 days). No mortality was recorded until now. Post-operatory left ventricular function was preserved in 90.9% of the patients. Only one patient had mild myocardial dysfunction at the time of discharge.
Primary arterial switch procedure can still be the best surgical option in patients with the diagnosis of transposition of the great arteries with intact ventricular septum beyond 8 weeks of age, providing that mechanical circulatory support and an expert cardiac intensive care unit service are available.
自动脉调转术应用以来，大动脉转位的预后已完全改变。进行该干预的时间限制仍存在争议。本研究的目的是证明在数月龄之后进行一期动脉调转术的早期和晚期结果。
我们纳入了所有年龄超过8周、诊断为室间隔完整的大动脉转位且接受一期动脉调转术的患者。手术由同一位外科医生在两个不同机构进行。排除患有大动脉转位及相关畸形（除房间隔缺损和动脉导管未闭外）的患者。在决定手术类型时未考虑心室形状、几何结构和质量。
在该研究中，11例年龄超过8周、诊断为单纯d型大动脉转位的患者接受了一期动脉调转术，平均年龄为90.63天（60 - 137天），7例患者进行了 Rashkind 手术。所有患者左心室形状扁平但功能保留。10例患者胸骨未闭合。45.45%的病例需要体外膜肺氧合支持。平均机械通气时间为7.27天（1 - 16天）。目前尚无死亡记录。90.9%的患者术后左心室功能得以保留。仅1例患者出院时存在轻度心肌功能障碍。
对于年龄超过8周、诊断为室间隔完整的大动脉转位患者，只要有机械循环支持和专业的心脏重症监护病房服务，一期动脉调转术仍是最佳的手术选择。
