心房调转修复术后大动脉D型转位患者生存的临床影响因素：一项荟萃分析。

Clinical factors affecting survival in patients with D-transposition of the great arteries after atrial switch repair: A meta-analysis.

作者信息

Nartowicz Sonia Alicja, Jakielska Ewelina, Ciepłucha Aleksandra, Ratajczak Piotr, Grajek Stefan, Lesiak Maciej, Trojnarska Olga

机构信息

Poznan University of Medical Sciences, Poznań, Poland.

1st Department of Cardiology, Poznan University of Medical Sciences, Poznań, Poland.

出版信息

Kardiol Pol. 2023;81(1):38-47. doi: 10.33963/KP.a2022.0209. Epub 2022 Sep 9.

DOI:10.33963/KP.a2022.0209

PMID:36082795

Abstract

BACKGROUND

Atrial switch repair (AtrSR) was the initial operation method in patients with D-transposition of the great arteries (D-TGA) constituting the right ventricle as a systemic one. Currently, it has been replaced with arterial switch operation (ASO), but the cohort of adults after AtrSR is still large and requires strict cardiological management of late complications. For this reason, we aimed to evaluate potential long-term mortality risk factors in patients with D-TGA after AtrSR (either Mustard or Senning procedures) Methods: We searched the MEDLINE database for suitable trials. We included 22 retrospective and prospective cohort studies of patients with D-TGA with at least 5 years mean/median follow-up time after Mustard or Senning procedures, with an endpoint of non-sudden cardiac death (n-SCD) and sudden cardiac death (SCD) after at least 30 days following surgery.

RESULTS

A total of 2912 patients were enrolled, of whom 351 met the combined endpoint of n-SCD/SCD. The long-term mortality risk factors were New York Heart Association (NYHA) class ≥III/heart failure hospitalization (odds ratio [OR], 7.25; 95% confidence interval [CI], 2.67-19.7), tricuspid valve regurgitation (OR, 4.64; 95% CI, 1.95-11.05), Mustard procedure (OR, 2.15; 95% CI, 1.37-3.35), complex D-TGA (OR, 2.41; 95% CI, 1.31-4.43), and right ventricular dysfunction (OR, 1.94; 95% CI, 0.99-3.79). Supraventricular arrhythmia (SVT; OR, 2.07; 95% CI, 0.88-4.85) and pacemaker implantation (OR, 2.37; 95% CI, 0.48-11.69) did not affect long-term survival in this group of patients. In an additional analysis, SVT showed a statistically significant impact on SCD (OR, 2.74; 95% CI, 1.36-5.53) but not on n-SCD (OR, 1.5; 95% CI, 0.37-6.0).

CONCLUSIONS

This meta-analysis demonstrated that at least moderate tricuspid valve regurgitation, NYHA class ≥III/heart failure hospitalization, right ventricular dysfunction, complex D-TGA, and Mustard procedure are risk factors for long-term mortality in patients after AtrSR.

摘要

背景

心房调转术（AtrSR）是大动脉转位（D-TGA）患者最初的手术方法，该方法使右心室作为体循环心室。目前，它已被动脉调转术（ASO）所取代，但接受AtrSR手术的成年患者队列仍然庞大，需要对晚期并发症进行严格的心脏病学管理。因此，我们旨在评估接受AtrSR（Mustard或Senning手术）的D-TGA患者潜在的长期死亡风险因素。方法：我们在MEDLINE数据库中搜索合适的试验。我们纳入了22项回顾性和前瞻性队列研究，研究对象为接受Mustard或Senning手术后平均/中位随访时间至少5年的D-TGA患者，终点为术后至少30天后的非心源性猝死（n-SCD）和心源性猝死（SCD）。

结果

共纳入2912例患者，其中351例符合n-SCD/SCD的联合终点。长期死亡风险因素包括纽约心脏协会（NYHA）心功能分级≥III级/心力衰竭住院（比值比[OR]，7.25；95%置信区间[CI]，2.67-19.7）、三尖瓣反流（OR，4.64；95%CI，1.95-11.05）、Mustard手术（OR，2.15；95%CI，1.37-3.35）、复杂D-TGA（OR，2.41；95%CI，1.31-4.43）和右心室功能障碍（OR，1.94；95%CI，0.99-3.79）。室上性心律失常（SVT；OR，2.07；95%CI，0.88-4.85）和起搏器植入（OR，2.37；95%CI，0.48-11.69）对该组患者的长期生存没有影响。在一项额外分析中，SVT对SCD有统计学显著影响（OR，2.74；95%CI，1.36-5.53），但对n-SCD没有影响（OR，1.5；95%CI，0.37-6.0）。