Gelatt M, Hamilton R M, McCrindle B W, Connelly M, Davis A, Harris L, Gow R M, Williams W G, Trusler G A, Freedom R M
Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
J Am Coll Cardiol. 1997 Jan;29(1):194-201. doi: 10.1016/s0735-1097(96)00424-x.
Our purpose was to assess the risk factors for late mortality, loss of sinus rhythm and atrial flutter after the Mustard operation.
The Mustard operation provides correction of cyanosis with low surgical risk in transposition of the great vessels. However, right ventricular failure, loss of sinus rhythm, atrial flutter and death are frequent long-term complications.
Records of 534 children who underwent the Mustard operation at a single center since 1962 were reviewed for demographic, anatomic, electrocardiographic and physiologic predictors and outcomes.
There were 52 early deaths (9.7%). Survival analysis was undertaken for 478 early survivors with a mean follow-up interval of 11.6 +/- 7.2 years. There were 77 late deaths (16.1%), with sudden death (n = 31) the most frequent cause. Survival estimates were 89% at 5 years and 76% at 20 years of age. Risk factors were an earlier date of operation, operative period arrhythmia and an associated ventricular septal defect. Risk (hazard) of late death declined in the first decade, with further peaks in the second decade. Sinus rhythm was present in 77% at 5 years and 40% at 20 years. Loss of sinus rhythm was associated with previous septectomy, postoperative bradycardia and late atrial flutter. Freedom from atrial flutter was 92% at 5 years and 73% at 20 years of age. Risk factors for atrial flutter were the occurrence of perioperative bradyarrhythmia, reoperation and loss of sinus rhythm during follow-up. Risk of atrial flutter demonstrates a late increase.
Ongoing loss of sinus rhythm and late peaks in the risk of atrial flutter and death necessitate continued follow-up.
我们的目的是评估Mustard手术后晚期死亡、窦性心律丧失和心房扑动的危险因素。
Mustard手术可在大血管转位时以较低的手术风险纠正紫绀。然而，右心室衰竭、窦性心律丧失、心房扑动和死亡是常见的长期并发症。
回顾了自1962年以来在单一中心接受Mustard手术的534例儿童的记录，以了解人口统计学、解剖学、心电图和生理学预测因素及结果。
有52例早期死亡（9.7%）。对478例早期幸存者进行了生存分析，平均随访间隔为11.6±7.2年。有77例晚期死亡（16.1%），猝死（n = 31）是最常见的原因。5岁时的生存估计为89%，20岁时为76%。危险因素为手术日期较早、手术期间心律失常和合并室间隔缺损。晚期死亡风险（危险度）在第一个十年下降，在第二个十年进一步出现高峰。5岁时77%的患者存在窦性心律，20岁时为40%。窦性心律丧失与既往房间隔切除术、术后心动过缓和晚期心房扑动有关。5岁时无心房扑动的比例为92%，20岁时为73%。心房扑动的危险因素为围手术期缓慢性心律失常的发生、再次手术和随访期间窦性心律丧失。心房扑动风险呈晚期增加。
窦性心律持续丧失以及心房扑动和死亡风险的晚期高峰需要持续随访。
