Hanley F L, Heinemann M K, Jonas R A, Mayer J E, Cook N R, Wessel D L, Castaneda A R
Department of Cardiovascular Surgery, Harvard Medical School, Children's Hospital of Boston, Mass.
J Thorac Cardiovasc Surg. 1993 Jun;105(6):1047-56.
From September 1986 through December 1991, 63 patients with truncus arteriosus underwent surgical repair. The management approach evolved over the period of the study from elective primary repair at 3 months of age to elective primary repair in the early neonatal period. Thirty variables were examined as potential risk factors for the outcome events of death, reoperation, and presence of pulmonary vascular morbidity. According to both univariate and multivariate techniques, severe truncal valve regurgitation, interrupted aortic arch, coronary artery anomalies, and age at repair greater than 100 days were important risk factors for perioperative death. In the 33 patients without these risk factors, early survival was 100%. In the 30 patients with one or more of these risk factors, survival was 63%. Pulmonary hypertensive episodes were fewer, and duration of ventilator dependence and pulmonary artery pressure were significantly less in patients undergoing the operation before 30 days of age. Seven patients required reoperation for right ventricular outflow tract obstruction at a mean follow-up time of 23.4 months, with no deaths. In conclusion, interrupted aortic arch, severe truncal valve insufficiency, coronary anomalies, and repair later than 100 days of age were risk factors for death after repair of truncus arteriosus. In the absence of these associations, truncus arteriosus can be repaired with excellent surgical outcome in the neonatal and early infancy period. Repair in the early neonatal period reduces the prevalence of postoperative pulmonary vascular morbidity.
从1986年9月至1991年12月，63例动脉干患者接受了手术修复。在研究期间，治疗方法从3个月大时的择期一期修复发展到新生儿早期的择期一期修复。研究了30个变量作为死亡、再次手术和肺血管疾病发生等结局事件的潜在危险因素。根据单变量和多变量技术，严重的动脉干瓣膜反流、主动脉弓中断、冠状动脉异常以及大于100天的修复年龄是围手术期死亡的重要危险因素。在没有这些危险因素的33例患者中，早期生存率为100%。在有一个或多个这些危险因素的30例患者中，生存率为63%。30天前接受手术的患者肺动脉高压发作较少，呼吸机依赖时间和肺动脉压力明显较低。7例患者在平均23.4个月的随访时间因右心室流出道梗阻需要再次手术，无死亡病例。总之，主动脉弓中断、严重的动脉干瓣膜关闭不全、冠状动脉异常以及大于100天的修复年龄是动脉干修复术后死亡的危险因素。在没有这些关联因素的情况下，动脉干在新生儿期和婴儿早期进行修复可获得良好的手术效果。新生儿早期修复可降低术后肺血管疾病的发生率。
