Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts.
Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Ann Thorac Surg. 2021 Apr;111(4):1367-1373. doi: 10.1016/j.athoracsur.2020.05.057. Epub 2020 Jun 27.
Outcomes after the arterial switch operation (ASO) for dextro-transposition of the great arteries have improved significantly since its inception in the 1980s. This study reviews contemporaneous outcomes and predictors for late reinterventions after ASO.
We retrospectively reviewed patients who underwent ASO for dextro-transposition of the great arteries from 1997 to 2017. Technical performance score (TPS) class (class 1, trivial or no residua; class 2, minor residua; class 3, major residua or reintervention) was assigned at discharge based on echocardiographic evaluation of components of the ASO. Multivariable Cox regression identified patient- and procedure-specific factors associated with postdischarge reinterventions.
Among 598 patients, 410 (69%) underwent ASO and 188 (31%) underwent ASO with ventricular septal defect repair. Median age at surgery was 5 days (interquartile range, 3 to 7); median follow-up time was 8.2 years; 408 (68%) were male; 50 (8.3%) were premature; and 10 (1.7%) had noncardiac anomalies or syndromes. Survival to hospital discharge was 98% (n = 591). Among 349 patients with follow-up, freedom from unplanned reintervent2ion at 5 years was 99% for TPS class 1, compared with 84% for class 2 and 30% for class 3. On multivariable Cox regression, classes 2 and 3 had significantly higher hazard for reintervention (class 2 hazard ratio 10.6; 95% confidence interval, 2.5 to 44.2; P = .001; class 3 hazard ratio 58.2, 95% confidence interval, 13.1 to 259; P < .001).
At our center, ASO was associated with relatively low mortality. Class 2 and class 3 TPS were the most important independent predictors of reinterventions after discharge. Therefore, TPS can serve as a tool for identifying high-risk patients who warrant closer follow-up.
自 20 世纪 80 年代以来，动脉调转术（ASO）治疗右旋位大动脉转位的术后效果已有显著改善。本研究回顾性分析了同期 ASO 术后晚期再干预的结果和预测因素。
我们回顾性分析了 1997 年至 2017 年期间因右旋位大动脉转位而行 ASO 的患者。根据 ASO 各部分的超声心动图评估，在出院时分配技术性能评分（TPS）类别（1 类，无或轻微残余；2 类，轻微残余；3 类，主要残余或再次干预）。多变量 Cox 回归分析确定了与出院后再干预相关的患者和手术特定因素。
在 598 例患者中，410 例（69%）行 ASO 术，188 例（31%）行 ASO 合并室间隔缺损修补术。手术时中位年龄为 5 天（四分位间距，3 至 7）；中位随访时间为 8.2 年；408 例（68%）为男性；50 例（8.3%）为早产儿；10 例（1.7%）有非心脏畸形或综合征。出院时生存率为 98%（n=591）。在 349 例有随访的患者中，TPS 1 类患者 5 年无计划再干预的比例为 99%，而 TPS 2 类和 3 类分别为 84%和 30%。多变量 Cox 回归分析显示，2 类和 3 类的再干预风险显著增加（2 类危险比为 10.6；95%置信区间，2.5 至 44.2；P=0.001；3 类危险比为 58.2；95%置信区间，13.1 至 259；P＜0.001）。
在我们中心，ASO 相关死亡率相对较低。2 类和 3 类 TPS 是出院后再干预的最重要独立预测因素。因此，TPS 可作为识别高危患者并需要密切随访的工具。
