Department of Cardiovascular Surgery, Children Heart Center, National Children's Hospital, Hanoi, Vietnam.
World J Pediatr Congenit Heart Surg. 2023 May;14(3):309-315. doi: 10.1177/21501351221151043. Epub 2023 Mar 9.
This study evaluates mortality and intermediate outcomes of the arterial switch operation (ASO) for transposition or Taussig-Bing anomaly with single sinus coronary artery (CA) anatomy in a high-volume cardiac program in Vietnam. We retrospectively reviewed and performed risk factor analysis pertaining to 41 consecutive patients who presented with single sinus CA anatomy and who underwent ASO from January 2010 to December 2016 in our center. The median age at operation was 43 days [interquartile range (IQR): 20-65] and the median weight was 3.6 kg (IQR: 3.4-4.0). Four in-hospital deaths (9.8%), of which one was related to coronary insufficiency. There were no late deaths, with a median follow-up time of 7.2 years. Survival for all patients with single sinus CA was 90.2% at 1 year and remained constant at 5 years and 10 years after ASO. The presence of a coexisting aortic arch anomaly was the only risk factor for overall mortality identified in this study (hazard ratio: 8.66, = .031, 95% confidence interval: 1.21-61.92). There were three cardiac reoperations. Freedom from reintervention after ASO for patients with single sinus CA at 1 year, 5 years, and 10 years were 97.3%, 91.9%, and 91.9%, respectively. Interestingly, among all patients undergoing ASO during this time period (n = 304), single-sinus CA anatomy was not a risk factor for overall death ( = .758). In a high-volume cardiac program in a lower middle-income country like Vietnam, ASO can be safely performed with single sinus CA anatomy, irrespective of the presenting coronary anatomy.
本研究评估了在越南一个高容量心脏项目中，动脉调转手术（ASO）治疗单窦冠状动脉（CA）解剖的大动脉转位或 Taussig-Bing 畸形的死亡率和中间结果。我们回顾性地分析了 2010 年 1 月至 2016 年 12 月期间在我们中心就诊的 41 例具有单窦 CA 解剖结构并接受 ASO 的连续患者，并进行了危险因素分析。手术时的中位年龄为 43 天[四分位间距（IQR）：20-65]，体重中位数为 3.6 公斤（IQR：3.4-4.0）。4 例院内死亡（9.8%），其中 1 例与冠状动脉供血不足有关。无晚期死亡，中位随访时间为 7.2 年。所有具有单窦 CA 的患者在 ASO 后 1 年的生存率为 90.2%，5 年和 10 年时生存率保持不变。本研究中唯一确定的总死亡率的危险因素是同时存在主动脉弓异常（风险比：8.66， = .031，95%置信区间：1.21-61.92）。有 3 例心脏再次手术。ASO 后 1 年、5 年和 10 年，单窦 CA 患者无再次干预的比例分别为 97.3%、91.9%和 91.9%。有趣的是，在这段时间内接受 ASO 的所有患者（n = 304）中，单窦 CA 解剖结构并不是总体死亡的危险因素（ = .758）。在越南这样的中低收入国家的高容量心脏项目中，ASO 可以安全地用于单窦 CA 解剖结构，而不论其冠状动脉解剖结构如何。
