Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky.
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2023;26:40-49. doi: 10.1053/j.pcsu.2022.12.009. Epub 2022 Dec 27.
Medical and surgical advances have allowed single-stage total repair in neonates born with complex congenital heart anomalies and aortic arch obstruction. Nonetheless, total repair might be too complex or high risk in certain neonates with demographic, clinical or morphologic risk factors. Alternative management strategies might offer these neonates better outcomes with superior anatomic repair, shorter hospitalization, reduced morbidity, and improved survival. Alternative initial surgical strategies might include aortic arch repair and pulmonary artery band with or without cardiopulmonary bypass, extracardiac repair only and pulmonary artery band, Norwood operation, and hybrid first-stage palliation; all deferring complex biventricular intra-cardiac repair to later stage. The strategy choice should be personalized to each patient, taking into consideration the morphologic and clinical state, and the existent goals of care.
医学和外科技巧的进步使得患有复杂先天性心脏畸形和主动脉弓阻塞的新生儿能够进行一期根治术。然而，对于某些存在人口统计学、临床或形态学危险因素的新生儿，根治术可能过于复杂或风险过高。替代管理策略可能为这些新生儿提供更好的结果，包括更优的解剖修复、更短的住院时间、更低的发病率和更高的生存率。替代的初始手术策略可能包括主动脉弓修复和肺动脉带，或伴有或不伴有体外循环、体外修复术和肺动脉带、Norwood 手术和杂交一期姑息术；所有这些都将复杂的双心室心内修复推迟到后期。策略选择应根据每个患者的具体情况进行个性化制定，考虑到形态和临床状态，以及现有的治疗目标。
