van Wijk Sebastiaan W H, Wulfse Maaike, Driessen Mieke M P, Slieker Martijn G, Doevendans Pieter A, Schoof Paul H, Sieswerda Gert Jan J, Breur Johannes M P J
Department of Pediatric Cardiology, Wilhelmina Children's Hospital, Utrecht, the Netherlands.
Department of Cardiology, Radboud UMC Nijmegen, Nijmegen, the Netherlands.
Int J Cardiol Congenit Heart Dis. 2023 Mar 23;12:100451. doi: 10.1016/j.ijcchd.2023.100451. eCollection 2023 Jun.
From 1977 onwards, patients with both simple and complex transposition of the great arteries (TGA) have been treated with the arterial switch operation (ASO) in the Wilhelmina Children's Hospital/University Medical Center Utrecht the Netherlands. In this study, we compared mortality and morbidity between two patient groups: A. operated before and B. after 1991, specifically focusing on late ventricular function and reinterventions.
A single institution retrospective cohort study was performed on patients who had an ASO for either simple or complex TGA. Data were collected from medical records. The entire patient cohort (n = 283) was divided in a group with more than 30 years of follow-up (A) and a group with less than 30 years of follow-up (B). Clinical and standardized echocardiographic follow-up was evaluated.
Group A consisted of 79 patients, of whom follow-up was available in 59 patients (median follow-up 34.8 years, IQR 33.0-36.9). Group B consisted of 204 patients, of whom 195 long-term survivors (median follow-up 14.9 years, IQR 10.0-21.2). Early survival was best in group B (A: 67.8% vs. B: 96.6%, p < 0.001), whereas late mortality (in total 1.8%) was similar for both groups. Reinterventions, corrected for follow-up time, were more frequent in group A (p = 0.005). In total 65 patients (25.1%) required 105 late reinterventions including 4 late aortic valve replacements. The mode of reinterventions has shifted over time, from surgical to more catheter-based (p = 0.03). The vast majority of patients functioned in NYHA class I. In contrast to the recent cohort, who have a normal average LVEF (%), the average LVEF in the oldest cohort was in the bottom percentile of normal range.
The majority of patients in their fifth decade after ASO are in functional class I. Early outcome improved showing reduced mortality and need for reoperation. However, a trend towards reduced left ventricular function and late aortic valve replacements justify further research.
自1977年起，荷兰乌得勒支大学医学中心威廉明娜儿童医院开始采用动脉调转术（ASO）治疗单纯型和复杂型大动脉转位（TGA）患者。在本研究中，我们比较了两组患者的死亡率和发病率：A组为1991年之前接受手术的患者，B组为1991年之后接受手术的患者，特别关注晚期心室功能和再次干预情况。
对因单纯型或复杂型TGA接受ASO手术的患者进行了一项单机构回顾性队列研究。数据从病历中收集。整个患者队列（n = 283）被分为随访时间超过30年的组（A组）和随访时间不足30年的组（B组）。对临床和标准化超声心动图随访情况进行了评估。
A组有79例患者，其中59例有随访数据（中位随访时间34.8年，四分位间距33.0 - 36.9年）。B组有204例患者，其中195例为长期存活者（中位随访时间14.9年，四分位间距10.0 - 21.2年）。B组早期生存率最佳（A组：67.8% 对B组：96.6%，p < 0.001），而两组晚期死亡率（总计1.8%）相似。校正随访时间后，A组再次干预更为频繁（p = 0.005）。共有65例患者（25.1%）需要进行105次晚期再次干预，其中包括4次晚期主动脉瓣置换术。再次干预的方式随时间发生了变化，从手术方式转变为更多基于导管的方式（p = 0.03）。绝大多数患者的心功能为纽约心脏协会（NYHA）I级。与近期队列患者平均左心室射血分数（LVEF）正常不同，最年长队列患者的平均LVEF处于正常范围的最低百分位数。
ASO术后第五个十年的大多数患者心功能为I级。早期结局有所改善，死亡率降低且再次手术需求减少。然而，左心室功能降低和晚期主动脉瓣置换术的趋势表明有必要进一步开展研究。
