Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167# Beilishi Road, Xicheng District, Beijing, 100037, China.
Pediatr Cardiol. 2021 Feb;42(2):417-424. doi: 10.1007/s00246-020-02499-5. Epub 2021 Feb 16.
To review the early and intermediate outcomes of patients with transposition of the great arteries (TGA) and intramural coronary artery (IMCA) who underwent arterial switch operation (ASO) at our center. Among 450 patients with TGA who underwent an ASO between 2010 and 2018, 26 (5.8%) patients were identified with IMCA. The left coronary artery was intramural in 21 of 26 patients. We adopted coronary transfer using double coronary buttons with unroofed intramural course for all 26 patients. Early mortality for patients with IMCA was 3 of 26 (11.5%) compared with 10 of 424 (2.4%) for those without IMCA (p = 0.007). Six patients suffered major adverse events, including extracorporeal membrane oxygenation support in 3 patients, delayed sternal closure in 6 patients. The follow-up was available for all 23 survivors, with the mean follow-up period of 73.5 ± 28.7 months. There was no late death and reinterventions, and all patients were asymptomatic at last follow-up. One patient exhibited moderate neopulmonary regurgitation, and 1 patient presented with distal stenosis of the right pulmonary artery. Coronary transfer using double coronary buttons with unroofed intramural course was a good option for patients with TGA and IMCA. With this technique, ASO could be performed with optimal early and intermediate outcomes.
回顾在我中心接受大动脉转位（TGA）和心外膜冠状动脉（IMCA）患者动脉调转手术（ASO）的早期和中期结果。在 2010 年至 2018 年间接受 ASO 的 450 例 TGA 患者中，有 26 例（5.8%）患者存在 IMCA。26 例患者中有 21 例左冠状动脉为心外膜内。我们对所有 26 例患者均采用带未覆盖心外膜内段的双冠状动脉纽扣进行冠状动脉转移。有 IMCA 的患者早期死亡率为 3 例（11.5%），而无 IMCA 的患者为 424 例中的 10 例（2.4%）（p=0.007）。6 例患者发生重大不良事件，其中 3 例需要体外膜肺氧合支持，6 例需要延迟胸骨闭合。所有 23 例幸存者均可获得随访，平均随访时间为 73.5±28.7 个月。无晚期死亡和再干预，所有患者在最后一次随访时均无症状。1 例患者出现中度肺动脉瓣反流，1 例患者出现右肺动脉远端狭窄。带未覆盖心外膜内段的双冠状动脉纽扣冠状动脉转移术是 TGA 和 IMCA 患者的一种较好选择。采用该技术，ASO 可获得最佳的早期和中期结果。
