Alkattan Hani N, Diraneyya Obayda M, Elmontaser Hatem A, Jaweed Joohum, Alsaiad Abdulsalam M, Arifi Ahmed A, Alghamdi Abdullah A
Department of cardiac science, Ministry of the National Guard - Health Affairs, Riyadh, Kingdom of Saudi Arabia.
King Abdullah International Medical Research Center,, Riyadh, Kingdom of Saudi Arabia.
J Card Surg. 2020 Nov;35(11):2927-2933. doi: 10.1111/jocs.14958. Epub 2020 Aug 16.
The arterial switch operation (ASO) is the standard treatment for the transposition of the great arteries. The timely variation in the residual pressure gradient across the pulmonary arteries is ill-defined. This study is aimed to study the progressive changes in the pressure gradient across the pulmonary valve and pulmonary arteries after ASO.
All eligible patients for this study who underwent ASO between 2000 and 2019 were reviewed. Transthoracic echocardiography was used to estimate the peak pressure gradient across the pulmonary artery and its branches. The primary outcome was the total peak pressure gradient (TPG) which is the sum of peak pressure gradients across the main pulmonary artery and pulmonary artery branches. Furthermore, longitudinal data analyses with mixed-effect modeling were used to determine the independent predictors for the changes in the pressure gradient.
Three hundred and nine patients were included in the study. Over a 17-year follow-up, the freedom from pulmonary stenosis reintervention was 95% (16 out of the 309 patients underwent reintervention = 5%). The longitudinal data analyses of serial 1844 echocardiographic studies for the included patients revealed that the TPG recorded in the first postoperative echocardiogram across pulmonary valve, right and left pulmonary artery branches was the most significant predictor for reintervention.
The total peak gradient measured in the first postoperative echocardiogram is the most important predictor for reintervention. We propose that a total peak gradient in the first postoperative echocardiography of 55 mm Hg or more is a predictor for reintervention.
动脉调转术（ASO）是大动脉转位的标准治疗方法。肺动脉残余压力梯度的适时变化尚不明确。本研究旨在探讨ASO术后肺动脉瓣和肺动脉压力梯度的动态变化。
回顾性分析2000年至2019年间所有接受ASO的符合条件的患者。经胸超声心动图用于评估肺动脉及其分支的峰值压力梯度。主要结局指标是总峰值压力梯度（TPG），即主肺动脉和肺动脉分支的峰值压力梯度之和。此外，采用混合效应模型进行纵向数据分析，以确定压力梯度变化的独立预测因素。
本研究共纳入309例患者。在17年的随访中，免于肺动脉狭窄再次干预的比例为95%（309例患者中有16例接受了再次干预，占5%）。对纳入患者的1844次系列超声心动图研究进行纵向数据分析显示，术后首次超声心动图记录的肺动脉瓣、右肺动脉和左肺动脉分支的TPG是再次干预的最显著预测因素。
术后首次超声心动图测量的总峰值梯度是再次干预的最重要预测因素。我们建议，术后首次超声心动图总峰值梯度≥55 mmHg是再次干预的预测指标。
