Planché C, Serraf A, Comas J V, Lacour-Gayet F, Bruniaux J, Touchot A
Université Paris Sud, Department of Pediatric Surgery, Marie Lannelongue Hospital, France.
J Thorac Cardiovasc Surg. 1993 May;105(5):925-33.
Between September 1, 1982, and March 1, 1992, 40 patients underwent anatomic repair of transposition of the great arteries, ventricular septal defect, and aortic arch obstruction. In group I, 26 patients (65%) underwent repair in a two-stage procedure, phases A and B. Phase A included repair of the aortic arch obstruction with (16 patients) or without (10 patients) pulmonary artery banding through a left thoracotomy (mean age 18.7 +/- 23.4 days). There were three deaths and three reoperations. Phase B included an arterial switch operation with closure of the ventricular septal defect (mean age 95.5 +/- 122 days). There were five early deaths and two late deaths. Eight patients required reoperation. Mean delay between phase A and phase B was 77.5 +/- 109 days. In group I, there were eight early and two late deaths, and 11 patients required reoperation. The mean stay in the intensive care unit was 24.7 +/- 20 days. Mean follow-up of 59.6 +/- 21.4 months was completed in all survivors. All but one were in New York Heart Association class I without medication. Actuarial survival rate and rate of freedom from reoperation at 5 years were 57.5% and 49.9%, respectively. In group II, 14 patients (35%) had a one-stage procedure through midsternotomy: an arterial switch operation with closure of the ventricular septal defect and repair of the aortic arch obstruction (mean age 10.2 +/- 5.5 days). There were two early deaths (14.2%) and one late death after reoperation for overlooked multiple ventricular septal defects. Two patients required reoperation. The mean stay in the intensive care unit was 11.7 +/- 2.5 days. Mean follow-up of 22.4 +/- 16.7 months was achieved in all survivors. They were all in New York Heart Association class I without medication. Actuarial survival rate and rate of freedom from reoperation at 3 years were 78.5% and 81.5%, respectively. The one-stage procedure allowed complete repair in neonates without the need for multiple operations. We believe that it may decrease early mortality rates (14.2% versus 30.7%), reduce the reoperation rate and cumulative stay in the intensive care unit (11.7 days versus 24.7 days, p = Not significant), and significantly decrease the overall rate of morbidity (p < 0.01). However, requirements for surgical intervention with a one-stage or a two-stage procedure must include accurate assessments of intracardiac and aortic arch anatomy.
1982年9月1日至1992年3月1日期间，40例患者接受了大动脉转位、室间隔缺损和主动脉弓梗阻的解剖修复术。在第一组中，26例患者（65%）接受了分两期进行的修复手术，即A期和B期。A期包括通过左胸切口修复主动脉弓梗阻（16例患者），有（10例患者）或无肺动脉环扎（平均年龄18.7±23.4天）。有3例死亡和3例再次手术。B期包括动脉调转术并关闭室间隔缺损（平均年龄95.5±122天）。有5例早期死亡和2例晚期死亡。8例患者需要再次手术。A期和B期之间的平均间隔为77.5±109天。在第一组中，有8例早期死亡和2例晚期死亡，并11例患者需要再次手术。在重症监护病房的平均住院时间为24.7±20天。所有幸存者均完成了平均59.6±21.4个月的随访。除1例患者外，其余均为纽约心脏协会I级，无需药物治疗。5年时的精算生存率和免于再次手术率分别为57.5%和49.9%。在第二组中，14例患者（35%）通过正中胸骨切开术进行了一期手术：动脉调转术并关闭室间隔缺损及修复主动脉弓梗阻（平均年龄10.2±5.5天）。有2例早期死亡（14.2%），1例因漏诊多个室间隔缺损再次手术后晚期死亡。2例患者需要再次手术。在重症监护病房的平均住院时间为11.7±2.5天。所有幸存者均完成了平均22.4±16.7个月的随访。他们均为纽约心脏协会I级，无需药物治疗。3年时的精算生存率和免于再次手术率分别为78.5%和81.5%。一期手术可在新生儿期完成完全修复，无需多次手术。我们认为，它可能降低早期死亡率（14.2%对30.7%），降低再次手术率和在重症监护病房的累计住院时间（11.7天对24.7天，p =无显著性差异），并显著降低总体发病率（p<0.01）。然而，采用一期或两期手术进行外科干预的要求必须包括对心脏内和主动脉弓解剖结构的准确评估。
