Quaegebeur J M, Rohmer J, Ottenkamp J, Buis T, Kirklin J W, Blackstone E H, Brom A G
J Thorac Cardiovasc Surg. 1986 Sep;92(3 Pt 1):361-84.
Sixty-six patients (23 neonates with transposition of the great arteries and intact ventricular septum, 33 infants and children with transposition and a large ventricular septal defect, and 10 with double-outlet right ventricle with a subpulmonary ventricular septal defect have received an arterial switch repair since 1977. Eight (one with transposition and intact ventricular septum, six with transposition and ventricular septal defect, and one with double-outlet right ventricle with subpulmonary ventricular septal defect) died in the hospital. All other patients have had follow-up as of June, 1985. Including the hospital deaths, the 11 month actuarial survival rate for the entire group was 81%, and no deaths have occurred among the 33 patients alive at that time and traced as long as 8 years. The hazard function for death has only a single early phase, and its 70% confidence limits overlap the hazard function of a matched general population by 12 months after the operation. Incremental risk factors for death included low birth weight (but not weight or age at operation), transposition of the great arteries with large ventricular septal defect, double-outlet right ventricle with subpulmonary ventricular septal defect, and presence of a patent ductus arteriosus. Coronary artery morphology and position of the great arteries were not risk factors. Long aortic cross-clamp time was possibly (p = 0.11) a risk factor. Early date of operation was a risk factor (p = 0.004); thus, predicted 1 year survival rate, including hospital deaths, after the arterial switch operation in 1985 is 99.9% (70% confidence limits 99.0%-100%) for neonates with transposition and intact ventricular septum and 99.7% (98.4%-99.9%) for those with transposition and a large ventricular septal defect or double-outlet right ventricle. The late functional status was excellent, and the rhythm was sinus in 96% of the 55 surviving patients. A formal comparison with the results of the atrial switch repair indicates that the arterial switch repair is superior.
自1977年以来，66例患者（23例患有大动脉转位且室间隔完整的新生儿、33例患有大动脉转位和大型室间隔缺损的婴幼儿以及10例患有右心室双出口且有肺动脉下室间隔缺损的患者）接受了动脉调转术修复。8例（1例大动脉转位且室间隔完整、6例大动脉转位且室间隔缺损、1例右心室双出口且有肺动脉下室间隔缺损）在医院死亡。截至1985年6月，所有其他患者均已接受随访。包括医院死亡病例在内，整个组的11个月精算生存率为81%，并且在当时存活且随访长达8年的33例患者中未发生死亡。死亡风险函数仅在早期有一个阶段，其70%置信区间在术后12个月与匹配的普通人群的风险函数重叠。死亡的增量风险因素包括低出生体重（但不是手术时的体重或年龄）、伴有大型室间隔缺损的大动脉转位、伴有肺动脉下室间隔缺损的右心室双出口以及动脉导管未闭的存在。冠状动脉形态和大动脉位置不是风险因素。较长的主动脉阻断时间可能（p = 0.11）是一个风险因素。早期手术日期是一个风险因素（p = 0.004）；因此，1985年动脉调转术后，包括医院死亡病例在内，患有大动脉转位且室间隔完整的新生儿的预测1年生存率为99.9%（70%置信区间99.0% - 100%），患有大动脉转位和大型室间隔缺损或右心室双出口的患者为99.7%（98.4% - 99.9%）。晚期功能状态良好，在55例存活患者中有96%的心律为窦性。与心房调转术修复结果的正式比较表明动脉调转术修复更优。
