Lee Yu Ri, Kim Dong-Hee, Choi Eun Seok, Yun Tae-Jin, Park Chun Soo
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Division of Pediatric Cardiac Surgery, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Chest Surg. 2023 Mar 5;56(2):75-86. doi: 10.5090/jcs.22.106. Epub 2023 Jan 30.
We investigated the long-term outcomes of truncus arteriosus repair at a single institution with a 30-year study period.
Patients who underwent repair of truncus arteriosus between 1993 and 2022 were reviewed retrospectively. Factors associated with early mortality, overall attrition, and reintervention were identified using appropriate statistical methods.
In total, 42 patients were enrolled in this study. The median age and weight at repair were 26 days and 3.5 kg, respectively. Thirty patients (71.4%) underwent 1-stage repair. There were 8 early deaths (19%). In the univariable analysis, undergoing surgery before 2011 was associated with early mortality (p=0.031). The overall survival rate at 10 years was 73.8%. In the multivariable analysis, significant truncal valve (TrV) dysfunction (p=0.010), longer cardiopulmonary bypass time (p=0.018), and the earlier era of surgery (p=0.004) were identified as risk factors for overall mortality. During follow-up, 47 reinterventions were required in 27 patients (64.3%). The freedom from all-cause reintervention rate at 10 years was 23.6%. In the multivariable analysis, associated arch obstruction (p<0.001) and significant TrV dysfunction (p=0.011) were identified as risk factors for all-cause reintervention. Arch obstruction (p=0.027) and a number of TrV cusps other than 3 (p=0.014) were identified as risk factors for right ventricle to pulmonary artery (RV-PA) reintervention, and significant TrV dysfunction was identified as a risk factor for TrV reintervention (p=0.002).
Despite recent improvements in survival outcomes after repair of truncus arteriosus, RV-PA or TrV reinterventions were required in a significant number of patients during follow-up.
我们在一个单一机构进行了为期30年的研究，调查了共同动脉干修复的长期结果。
回顾性分析1993年至2022年间接受共同动脉干修复的患者。使用适当的统计方法确定与早期死亡率、总体损耗和再次干预相关的因素。
本研究共纳入42例患者。修复时的中位年龄和体重分别为26天和3.5千克。30例患者（71.4%）接受了一期修复。有8例早期死亡（19%）。在单变量分析中，2011年前接受手术与早期死亡率相关（p=0.031）。10年时的总生存率为73.8%。在多变量分析中，严重的共同动脉干瓣膜（TrV）功能障碍（p=0.010）、较长的体外循环时间（p=0.018）和较早的手术时代（p=0.004）被确定为总体死亡率的危险因素。在随访期间，27例患者（64.3%）需要进行47次再次干预。10年时无全因再次干预率为23.6%。在多变量分析中，相关的主动脉弓梗阻（p<0.001）和严重的TrV功能障碍（p=0.011）被确定为全因再次干预的危险因素。主动脉弓梗阻（p=0.027）和非3个TrV瓣叶数量（p=0.014）被确定为右心室至肺动脉（RV-PA）再次干预的危险因素，严重的TrV功能障碍被确定为TrV再次干预的危险因素（p=0.002）。
尽管近期共同动脉干修复后的生存结果有所改善，但在随访期间仍有相当数量的患者需要进行RV-PA或TrV再次干预。
