Anzai Isao, Zhao Yanling, Dimagli Arnaldo, Pearsall Christian, LaForest Marian, Bacha Emile, Kalfa David
Department of Surgery, Division of Cardiac, Thoracic, and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, USA.
Department of Cardiothoracic Surgery, 12295Weill Cornell Medicine, New York, NY, USA.
World J Pediatr Congenit Heart Surg. 2023 Jan;14(1):70-76. doi: 10.1177/21501351221127894.
Surgical treatment for congenitally corrected transposition of the great arteries is widely debated, with both physiologic repair and anatomic repair holding advantages and disadvantages. This meta-analysis, which includes 44 total studies consisting of 1857 patients, compares mortality at different time points (operative, in-hospital, and post-discharge), reoperation rates, and postoperative ventricular dysfunction between these two categories of procedures. Although anatomic and physiologic repair had similar operative and in-hospital mortality, anatomic repair patients had significantly less post-discharge mortality (6.1% vs 9.7%; = .006), lower reoperation rates (17.9% vs 20.6%; < .001), and less postoperative ventricular dysfunction (16% vs 43%; < .001). When anatomic repair patients were subdivided into those who had atrial and arterial switch versus those who had atrial switch with Rastelli, the double switch group had significantly lower in-hospital mortality (4.3% vs 7.6%; = .026) and reoperation rates (15.6% vs 25.9%; < .001). The results of this meta-analysis suggest a protective benefit of favoring anatomic repair over physiologic repair.
大动脉转位矫正术的手术治疗存在广泛争议，生理修复和解剖修复各有优缺点。这项荟萃分析纳入了44项研究，共1857例患者，比较了这两类手术在不同时间点（手术时、住院期间和出院后）的死亡率、再次手术率以及术后心室功能障碍情况。虽然解剖修复和生理修复的手术死亡率和住院死亡率相似，但解剖修复患者出院后的死亡率显著更低（6.1%对9.7%；P = 0.006），再次手术率更低（17.9%对20.6%；P < 0.001），术后心室功能障碍也更少（16%对43%；P < 0.001）。当将解剖修复患者细分为接受心房和动脉调转术的患者与接受心房调转术加Rastelli手术的患者时，双调转术组的住院死亡率（4.3%对7.6%；P = 0.026）和再次手术率（15.6%对25.9%；P < 0.001）显著更低。这项荟萃分析的结果表明，相较于生理修复，解剖修复具有保护优势。
