Department of Cardiovascular Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Thorac Cardiovasc Surg. 2023 Oct;166(4):1189-1199.e4. doi: 10.1016/j.jtcvs.2023.05.030. Epub 2023 Jun 7.
For transposition of the great arteries with unrestricted ventricular septal defect and pulmonary stenosis, double-root translocation is reported to reconstruct ideal double artery roots with growth potential. However, prospective long-term studies describing the long-term outcomes are still scarce. Therefore, the aim was to assess development of double artery roots, hemodynamics, and freedom from death and heart failure 17 years after double-root translocation, Rastelli, and Réparation à l'Etage Ventriculaire procedures.
In this prospective population-based study, 266 patients with transposition of the great arteries/ventricular septal defect/pulmonary stenosis (from July 2004 to August 2021) were consecutively included before surgery. All patients were divided into 3 groups based on the type of operation: double-root translocation (174), Rastelli (68), and Réparation à l'Etage Ventriculaire (24), who accepted postoperative evaluations annually. Generalized linear mixed model analysis was performed to determine growth potential of artery roots.
Longitudinal repeated computed tomography measurements show the pulmonary root has significantly increased diameter (0.62 [0.03] mm/y, P < .001) over time and an adequate Z-score (-0.18) at the last follow-up only in the double-root translocation group. The pressure gradients of double outflow tracts in the double-root translocation group were the least among 3 groups. The probabilities of freedom from death/heart failure at the 15th year were 73.1%, 59.3%, and 60.9% in the double-root translocation, Rastelli, and Réparation à l'Etage Ventriculaire groups, respectively (double-root translocation vs Rastelli, P = .026; double-root translocation vs Réparation à l'Etage Ventriculaire, P = .009; Rastelli vs Réparation à l'Etage Ventriculaire, P = .449).
By reconstructing ideal double artery roots, double-root translocation can provide postoperative long-term excellent hemodynamics and minimal death and heart failure for patients with transposition of the great arteries/ventricular septal defect/pulmonary stenosis.
对于大动脉转位合并无限制室间隔缺损和肺动脉瓣狭窄的患者，双根移位术被报道可以重建具有生长潜力的理想双动脉根。然而，描述长期结果的前瞻性长期研究仍然很少。因此，本研究旨在评估大动脉转位/室间隔缺损/肺动脉瓣狭窄患者在接受双根移位术、Rastelli 术和房室隔修补术 17 年后双动脉根的发育、血流动力学以及免于死亡和心力衰竭的情况。
在这项前瞻性基于人群的研究中，连续纳入了 2004 年 7 月至 2021 年 8 月期间接受大动脉转位/室间隔缺损/肺动脉瓣狭窄手术的 266 例患者。所有患者根据手术类型分为 3 组：双根移位组（174 例）、Rastelli 组（68 例）和房室隔修补组（24 例），术后每年接受一次评估。采用广义线性混合模型分析来确定动脉根的生长潜力。
纵向重复 CT 测量显示，肺动脉根部的直径随时间显著增加（0.62 [0.03]mm/y，P<.001），仅在双根移位组的最后一次随访中达到适当的 Z 分数（-0.18）。双根移位组的双流出道压力梯度最小。在第 15 年时，双根移位组、Rastelli 组和房室隔修补组免于死亡/心力衰竭的概率分别为 73.1%、59.3%和 60.9%（双根移位组与 Rastelli 组比较，P=.026；双根移位组与房室隔修补组比较，P=.009；Rastelli 组与房室隔修补组比较，P=.449）。
通过重建理想的双动脉根，双根移位术可为大动脉转位/室间隔缺损/肺动脉瓣狭窄患者提供术后长期良好的血流动力学以及最小的死亡和心力衰竭风险。
