Division of Congenital Heart Surgery, Texas Children's Hospital, Department of Surgery, Baylor College of Medicine, Houston, Texas.
Division of Congenital Heart Surgery, Texas Children's Hospital, Department of Surgery, Baylor College of Medicine, Houston, Texas.
Ann Thorac Surg. 2021 Dec;112(6):2005-2011. doi: 10.1016/j.athoracsur.2020.08.082. Epub 2020 Nov 18.
Truncus arteriosus is associated with coronary anomalies. We identified coronary artery lesions in patients undergoing repair of truncus arteriosus, defined the impact of lesions on mortality, and studied the effect of surgical intervention of coronary lesions.
A retrospective review identified 107 patients with truncus repair (1995-2019). Coronary lesions were categorized as ostial stenosis, intramural, juxtacommissural origin, and single coronary. Survival analysis characterized survival after truncus repair and studied the association of coronary lesions and mortality.
Among 107 patients with truncus repair 34 patients had at least 1 coronary lesion. Median follow-up time was 7 years, with 85% 5-year survival. Coronary lesions including ostial stenosis, intramurality, and juxtacommissural origin were associated with increased mortality, whereas single coronaries did not impact survival. Eleven patients had 1 coronary lesion and 6 patients with 2 coronary lesions had similar (80% and 83%, respectively) 5-year survival. Eight patients with 3 coronary lesions had 24% 5-year survival (P = .0003). Among patients with 1 or 2 lesions, surgical intervention on the coronary lesions tended to be associated with longer 5-year survival (100% vs 62%, respectively; P = .06). All patients with 3 lesions underwent coronary artery intervention, with 24% 5-year survival.
Impact of coronary lesions on mortality after truncus repair increases with the number of lesions. Coronary artery intervention may be associated with improved time-related survival among patients with 1 or 2 lesions. Patients with the most complex anomalies (3 lesions) have poor survival and warrant ongoing study of repair techniques.
动脉干畸形与冠状动脉异常相关。我们在接受动脉干修复的患者中发现了冠状动脉病变，定义了病变对死亡率的影响，并研究了冠状动脉病变的手术干预效果。
回顾性分析确定了 107 例动脉干修复患者（1995-2019 年）。冠状动脉病变分为开口狭窄、壁内、近吻合口起源和单支冠状动脉。生存分析描述了动脉干修复后的生存情况，并研究了冠状动脉病变与死亡率的关系。
在 107 例接受动脉干修复的患者中，有 34 例至少有 1 处冠状动脉病变。中位随访时间为 7 年，5 年生存率为 85%。冠状动脉病变包括开口狭窄、壁内和近吻合口起源与死亡率增加相关，而单支冠状动脉则不影响生存。11 例患者有 1 处冠状动脉病变，6 例患者有 2 处冠状动脉病变，5 年生存率分别为 80%和 83%（分别）。8 例有 3 处冠状动脉病变患者的 5 年生存率为 24%（P=0.0003）。在有 1 或 2 处病变的患者中，对冠状动脉病变进行手术干预倾向于与更长的 5 年生存率相关（分别为 100%和 62%；P=0.06）。所有有 3 处病变的患者均接受了冠状动脉介入治疗，5 年生存率为 24%。
冠状动脉病变对动脉干修复后死亡率的影响随着病变数量的增加而增加。冠状动脉介入治疗可能与 1 或 2 处病变患者的时间相关生存改善相关。病变最复杂（3 处病变）的患者生存率较差，需要对修复技术进行持续研究。
