Nellis Joseph R, Scherba Jacob C, Meza James M, Turek Joseph W, Andersen Nicholas D
Division of Cardiothoracic Surgery, Department of Surgery, Duke University Hospital, Durham, North Carolina.
Duke University School of Medicine, Duke University, Durham, North Carolina.
Ann Thorac Surg Short Rep. 2024 May 22;2(4):815-819. doi: 10.1016/j.atssr.2024.04.025. eCollection 2024 Dec.
This study sought to determine the safety of primary and staged biventricular repair in neonates with interrupted aortic arch (IAA), ventricular septal defect (VSD), and severe left ventricular outflow tract obstruction (LVOTO).
Patients with a fundamental diagnosis of IAA and VSD between 2015 and 2020 were extracted from The Society of Thoracic Surgeons National Database by using a Participant User File. The objective was to compare outcomes for neonates undergoing primary and staged Yasui and Ross operations. Primary end points were operative morbidity and mortality.
During the study period, 11.4% (123 of 1079) of neonates with a fundamental diagnosis of IAA and VSD underwent operations indicative of severe LVOTO. Of these patients, 42 (34%) underwent primary biventricular repair (Yasui or Ross/Ross-Konno), and 81 underwent a potential staging procedure (Norwood or hybrid stage I). No differences were observed in preoperative patient characteristics between groups. Neonates undergoing staged repair experienced fewer major complications (0 vs 1; = .04) and total complications (2 vs 4; = .02), but similar operative mortality (5% vs 12%; = .27) as neonates undergoing primary repair. A total of 58 patients undergoing Rastelli, biventricular repair, Yasui, or Ross/Ross-Konno operations with a diagnosis of IAA and VSD and history of neonatal Norwood or hybrid stage I procedures were also identified. Operative mortality for second-stage biventricular conversion operations was 2% (1 of 58). Only 4 centers performed 1 or more complex biventricular repairs for IAA and VSD with LVOTO per year.
Primary and staged biventricular repairs for IAA and VSD with LVOTO are associated with low operative mortality in the modern era and may be favorable to long-term single-ventricle palliation.
本研究旨在确定对患有主动脉弓中断（IAA）、室间隔缺损（VSD）和严重左心室流出道梗阻（LVOTO）的新生儿进行一期和分期双心室修复的安全性。
通过使用参与者用户文件，从胸外科医师协会国家数据库中提取2015年至2020年间基本诊断为IAA和VSD的患者。目的是比较接受一期和分期安井手术及罗斯手术的新生儿的结局。主要终点是手术发病率和死亡率。
在研究期间，基本诊断为IAA和VSD的新生儿中有11.4%（1079例中的123例）接受了提示严重LVOTO的手术。在这些患者中，42例（34%）接受了一期双心室修复（安井手术或罗斯/罗斯-康诺手术），81例接受了可能的分期手术（诺伍德手术或一期杂交手术）。两组患者术前特征无差异。接受分期修复的新生儿发生的主要并发症较少（0例对1例；P = 0.04），总并发症也较少（2例对4例；P = 0.02），但与接受一期修复的新生儿手术死亡率相似（5%对12%；P = 0.27）。还确定了58例接受了诊断为IAA和VSD且有新生儿诺伍德手术或一期杂交手术史的Rastelli手术、双心室修复、安井手术或罗斯/罗斯-康诺手术的患者。二期双心室转换手术的手术死亡率为2%（58例中的1例）。每年只有4个中心对IAA和VSD合并LVOTO进行1次或更多次复杂的双心室修复。
在现代，对IAA和VSD合并LVOTO进行一期和分期双心室修复手术死亡率较低，可能有利于长期单心室姑息治疗。
