Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, 430022, China.
Curr Med Sci. 2022 Jun;42(3):642-649. doi: 10.1007/s11596-022-2591-7. Epub 2022 May 17.
The influence of the coronary artery anatomy on the prognosis of patients receiving an arterial switch operation (ASO) is currently controversial, and the risk factors for this operation may change in more complicated patients. This study aimed to investigate the influence of coronary artery anomalies on the in-hospital and post-discharge outcomes of ASO in patients with transposition of the great arteries (TGA) and Taussig-Bing anomaly (TBA).
We retrospectively reviewed 206 patients who underwent ASO from January 2007 to December 2019. The median age at operation was 33 [interquartile range (IQR): 20-71] days. Median follow-up time was 7.2 years (IQR: 4.0-10.3 years).
Coronary anomalies were present in 86 patients (41.7%), with 9 (4.4%) of them having a single coronary artery. Additional coronary features included intramural courses in 5 (2.4%) patients, ostial stenosis in 1 (0.5%) patient, and accessory coronary artery orifices in 5 (2.4%) patients. There were 32 (15.5%) in-hospital deaths and 8 (4.6%) post-discharge deaths, yielding an overall survival of 81.3%, 80.7% and 79.9% at 1, 5 and 10 years, respectively. Mortality due to ASO has been drastically decreased since 2013. Patients with a single coronary artery had higher rate of in-hospital mortality, but this finding was not statistically significant. The earlier surgical era (OR: 2.756) and a longer cardiopulmonary bypass time (OR: 2.336) were significantly associated with in-hospital mortality, while coronary patterns were not. An intramural coronary artery (HR: 10.034) and a patient age of older than 1 year at the time of ASO (HR: 9.706) were independent predictors of post-discharge mortality.
ASO remains the procedure of choice for TGA with coronary anomalies with acceptable in-hospital and post-discharge outcomes in terms of overall survival and freedom of reoperation. However, intramural coronary artery is an independent risk factor for post-discharge mortality. Timely surgery within the 1st year of life helps improve overall midterm survival of ASO.
冠状动脉解剖结构对接受大动脉调转术(arterial switch operation,ASO)患者预后的影响目前仍存在争议,而且该手术的风险因素在更为复杂的患者中可能会发生变化。本研究旨在探讨冠状动脉畸形对大动脉转位(transposition of the great arteries,TGA)伴肺动脉瓣下狭窄(Taussig-Bing anomaly,TBA)患者行 ASO 术的住院和出院后结局的影响。
我们回顾性分析了 206 例 2007 年 1 月至 2019 年 12 月期间接受 ASO 的患者。手术时的中位年龄为 33 天(四分位距[interquartile range,IQR]:2071 天)。中位随访时间为 7.2 年(IQR:4.010.3 年)。
86 例(41.7%)患者存在冠状动脉畸形,其中 9 例(4.4%)为单支冠状动脉。其他冠状动脉特征包括 5 例(2.4%)存在冠状动脉走行异常,1 例(0.5%)存在冠状动脉开口狭窄,5 例(2.4%)存在副冠状动脉。住院期间共有 32 例(15.5%)死亡,8 例(4.6%)出院后死亡,1、5、10 年的总体生存率分别为 81.3%、80.7%和 79.9%。自 2013 年以来,由于 ASO 导致的死亡率明显下降。单支冠状动脉患者的住院死亡率较高,但差异无统计学意义。较早的手术时期(OR:2.756)和较长的体外循环时间(OR:2.336)与住院死亡率显著相关,而冠状动脉类型则无明显相关性。存在壁内冠状动脉(HR:10.034)和 ASO 时年龄大于 1 岁(HR:9.706)是出院后死亡的独立预测因素。
对于伴有冠状动脉畸形的 TGA,ASO 仍然是首选治疗方法,在总体生存率和再次手术的自由方面,住院和出院后结局可接受。然而,壁内冠状动脉是出院后死亡的独立危险因素。在 1 岁以内及时手术有助于提高 ASO 的中期总体生存率。