University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom.
Children's Heart Center at Kepler Universitätsklinikum, Linz, Austria; Johannes Kepler University, Medical Faculty, Linz, Austria.
J Thorac Cardiovasc Surg. 2022 Nov;164(5):1249-1260. doi: 10.1016/j.jtcvs.2022.05.047. Epub 2022 Jul 20.
There are several choices for the correction of complex transposition of the great arteries and double outlet right ventricle not amenable to the Rastelli-type surgery, but outcome data are limited to small series. This study aims to report results after the aortic root translocation and en bloc rotation of the outflow tract procedures.
This is a retrospective, multicentric, observational study. Clinical, anatomy, procedural, and detailed follow-up data (median, 4.43 years) were collected.
A total of 70 patients (62.9% male; median age, 1 year; range 4 days to 12.4 years) were included: n = 43 in the aortic root translocation group and n = 27 in the en bloc rotation group. Those in the aortic root translocation group were older (P = .01) and more likely to have had previous procedures (P < .0001), but cardiac anatomy was similar in both groups. Aortic root translocation and en bloc rotation early mortality (30 days) was similar (4.7% vs 3.7%, P = .8). Late survival and freedom from any cardiac reintervention were 92.7% and 16.9% at 15 years overall, respectively. Freedom from right ventricular outflow tract/conduit reintervention was better in the en bloc rotation group than in the aortic root translocation group (100% vs 24.5%, P = .0003), but more patients in the en bloc rotation group had moderate (or worse) aortic valve regurgitation during follow-up (16% vs 2.6%, P = .07).
Both aortic root translocation and en bloc rotation are valuable surgical options for the treatment of complex transposition of the great arteries and double outlet right ventricle. In the en bloc rotation group, there was better freedom from right ventricular outflow tract reinterventions, but a higher probability of aortic valve regurgitation. Identifying the main driving forces for these observed differences requires further study of these procedures.
对于不适合 Rastelli 手术的复杂大动脉转位和双出口右心室，有几种矫正方法可供选择，但结果数据仅限于小系列。本研究旨在报告主动脉根部移位和流出道整块旋转手术的结果。
这是一项回顾性、多中心、观察性研究。收集了临床、解剖、程序和详细随访数据（中位数为 4.43 年）。
共纳入 70 例患者（62.9%为男性；中位年龄为 1 岁；范围为 4 天至 12.4 岁）：主动脉根部移位组 n=43 例，整块旋转组 n=27 例。主动脉根部移位组患者年龄较大（P=0.01），更有可能有先前的手术（P<0.0001），但两组的心脏解剖相似。主动脉根部移位和整块旋转的早期死亡率（30 天）相似（4.7%对 3.7%，P=0.8）。总的来说，15 年的晚期存活率和无任何心脏再介入治疗的生存率分别为 92.7%和 16.9%。整块旋转组的右心室流出道/导管再介入治疗的无复发率优于主动脉根部移位组（100%对 24.5%，P=0.0003），但在整块旋转组中有更多的患者在随访期间出现中度（或更差）主动脉瓣反流（16%对 2.6%，P=0.07）。
主动脉根部移位和整块旋转都是治疗复杂大动脉转位和双出口右心室的有效手术选择。在整块旋转组中，右心室流出道再介入治疗的无复发率更高，但主动脉瓣反流的可能性更高。确定这些观察到的差异的主要驱动因素需要进一步研究这些程序。
