Chatterjee Arka, Miller Neal J, Cribbs Marc G, Mukherjee Amrita, Law Mark A
Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL 35294, United States.
Department of Epidemiology, University of Alabama at Birmingham School of Public health, Birmingham, AL 35233, United States.
World J Cardiol. 2020 Aug 26;12(8):427-436. doi: 10.4330/wjc.v12.i8.427.
Treatment of congenitally corrected transposition of great arteries (cc-TGA) with anatomic repair strategy has been considered superior due to restoration of the morphologic left ventricle in the systemic circulation. However, data on long term outcomes are limited to single center reports and include small sample sizes.
To perform a systematic review and meta-analysis for observational studies reporting outcomes on anatomic repair for cc-TGA.
MEDLINE and Scopus databases were queried using predefined criteria for reports published till December 31, 2017. Studies reporting anatomic repair of minimum 5 cc-TGA patients with at least a 2 year follow up were included. Meta-analysis was performed using Comprehensive meta-analysis v3.0 software.
Eight hundred and ninety-five patients underwent anatomic repair with a pooled follow-up of 5457.2 patient-years (PY). Pooled estimate for operative mortality was 8.3% [95% confidence interval (CI): 6.0%-11.4%]. 0.2% (CI: 0.1%-0.4%) patients required mechanical circulatory support postoperatively and 1.7% (CI: 1.1%-2.4%) developed post-operative atrioventricular block requiring a pacemaker. Patients surviving initial surgery had a transplant free survival of 92.5% (CI: 89.5%-95.4%) per 100 PY and a low rate of need for pacemaker (0.3/100 PY; CI: 0.1-0.4). 84.7% patients (CI: 79.6%-89.9%) were found to be in New York Heart Association (NYHA) functional class I or II after 100 PY follow up. Total re-intervention rate was 5.3 per 100 PY (CI: 3.8-6.8).
Operative mortality with anatomic repair strategy for cc-TGA is high. Despite that, transplant free survival after anatomic repair for cc-TGA patients is highly favorable. Majority of patients maintain NYHA I/II functional class. However, monitoring for burden of re-interventions specific for operation type is very essential.
由于在体循环中恢复了形态学上的左心室，采用解剖修复策略治疗先天性矫正型大动脉转位（cc-TGA）被认为更具优势。然而，关于长期预后的数据仅限于单中心报告，且样本量较小。
对报告cc-TGA解剖修复预后的观察性研究进行系统评价和荟萃分析。
使用预定义标准查询MEDLINE和Scopus数据库，检索截至2017年12月31日发表的报告。纳入报告至少5例cc-TGA患者进行解剖修复且随访至少2年的研究。使用Comprehensive meta-analysis v3.0软件进行荟萃分析。
895例患者接受了解剖修复，汇总随访时间为5457.2患者年（PY）。手术死亡率的汇总估计为8.3%[95%置信区间（CI）：6.0%-11.4%]。0.2%（CI：0.1%-0.4%）的患者术后需要机械循环支持，1.7%（CI：1.1%-2.4%）发生术后房室传导阻滞需要起搏器。初次手术后存活的患者每100 PY的无移植生存率为92.5%（CI：89.5%-95.4%），起搏器需求率较低（0.3/100 PY；CI：0.1-0.4）。随访100 PY后，84.7%的患者（CI：79.6%-89.9%）纽约心脏协会（NYHA）心功能分级为I或II级。总再次干预率为每100 PY 5.3次（CI：3.8-6.8）。
cc-TGA解剖修复策略的手术死亡率较高。尽管如此，cc-TGA患者解剖修复后的无移植生存率非常可观。大多数患者维持NYHA I/II心功能分级。然而，针对手术类型监测再次干预的负担非常重要。
