Center of Cardiothoracic Surgery, Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Vilnius University Faculty of Medicine, Santariskiu St. 2, LT-08661 Vilnius, Lithuania.
Clinic of Anesthesiology and Intensive Care, Institute of Clinical Medicine, Vilnius University Faculty of Medicine, Santariskiu St. 2, LT-08661 Vilnius, Lithuania.
Medicina (Kaunas). 2021 Aug 30;57(9):906. doi: 10.3390/medicina57090906.
: The results of the arterial switch operation in large congenital heart centers are excellent, and the results in small and medium centers are improving. The objective of this article is to share our experience utilizing the international knowledge transfer program to improve early and late arterial switch operation outcomes in our center. : A retrospective analysis of patients who underwent the arterial switch operation in Vilnius University Santaros Clinics Cardiothoracic Surgery Center between 1977-2020 was performed. : A total of 127 consecutive arterial switch operations were performed in our center. Surgical mortality during the entire study period was 24.6%. Surgical mortality prior to the program, during the program, and after the program was 88.24%, 41.7%, and 5.81%, respectively ( < 0.0001). The surgical mortality of patients operated on during the last 10 years was 4%. The overall survival estimate for the 97 surviving patients was 96.9%, 94.9%, 93.8%, 93.8%, 93.8%, 93.8% at 1, 3, 5, 10, 15, and 20 years, respectively. Risk factors for early mortality included longer aortic cross-clamp time and operation prior to the knowledge transfer program. The only significant risk factor for late reintervention was concomitant aortic arch obstruction treated at the time of the arterial switch. : The surgical treatment of transposition of the great arteries by means of an arterial switch with good results can be possible in low-to-medium volume congenital heart surgery centers. International knowledge transfer programs between high-expertise high-volume congenital heart centers and low-to-medium volume congenital heart centers may help to shorten the learning curve and improve early and late outcomes after an arterial switch. The risk factors for surgical mortality and intervention-free survival in low-volume surgical centers are similar to those in high-volume centers. Late arterial switch-related complications are similar to those among different-sized congenital heart centers.
: 大动脉调转术在大型先心病中心的效果非常出色，而中小中心的效果也在不断改善。本文的目的是分享我们利用国际知识转移项目来提高本中心早期和晚期大动脉调转术效果的经验。: 对 1977 年至 2020 年间在维尔纽斯大学桑塔罗斯临床心脏外科中心接受大动脉调转术的患者进行了回顾性分析。: 在我们中心共进行了 127 例连续的大动脉调转术。整个研究期间的手术死亡率为 24.6%。在项目之前、项目期间和项目之后，手术死亡率分别为 88.24%、41.7%和 5.81%（<0.0001）。在过去 10 年接受手术的患者中，手术死亡率为 4%。97 例存活患者的总体生存率估计分别为 1、3、5、10、15 和 20 年时的 96.9%、94.9%、93.8%、93.8%、93.8%和 93.8%。早期死亡的危险因素包括主动脉阻断时间较长和在知识转移项目之前进行手术。晚期再次干预的唯一显著危险因素是在大动脉调转时同时伴有主动脉弓阻塞。: 通过大动脉调转术治疗大动脉转位可以取得良好的效果，即使在低容量的先天性心脏病手术中心也可以实现。高专业、高容量的先天性心脏病中心与低容量的先天性心脏病中心之间的国际知识转移项目可能有助于缩短学习曲线，并提高大动脉调转术后的早期和晚期结果。低容量手术中心的手术死亡率和无干预生存率的危险因素与高容量中心相似。晚期与大动脉调转相关的并发症与不同规模的先天性心脏病中心相似。
