Tamisier D, Ouaknine R, Pouard P, Mauriat P, Lefebvre D, Sidi D, Vouhé P R
Department of Cardiac Surgery, Laënnec Hospital 42, Paris, France.
Eur J Cardiothorac Surg. 1997 May;11(5):810-7. doi: 10.1016/s1010-7940(97)01178-0.
To determine the incidence of coronary events following neonatal arterial switch and to identify potential risk factors for death and coronary events.
The total experience (236 consecutive arterial switch operations) of one surgeon was studied. Associated procedures included ventricular septal defect closure in 37 patients (16%) and aortic arch repair in 14 patients (6%)). The influence of various patient, procedural, support technique and experience variables was analyzed.
There were 19 deaths (8-70% confidence limits = 6-10%). Survival at 1 month, 1 year and 5 years was 93, 92 and 92%, respectively. Risk factors for death included small birth weight (P = 0.0015), hypoplasia of right ventricle (P < 0.0001), aortic arch obstruction (P < 0.0001) and coronary patterns with coronary arteries coursing between the great arteries (P = 0.0066). Coronary events occurred in 26 patients (11-70% confidence limits = 9-13%) and involved coronary deaths (11 patients), non fatal myocardial infarctions (8 patients) and coronary stenoses or occlusions (7 patients). Freedom from coronary events at 1 month, 1 year and 5 years was 94, 91 and 88%, respectively. Risk factors for coronary events included coronary patterns with retropulmonary course of the left main or left circumflex coronary artery (P = 0.0122), coronary patterns with coronary arteries coursing between the great arteries (P < 0.0001), all variations of intramural coronary arteries (P = 0.0010) and commissural origin of coronary ostia (P = 0.0171).
(1) In most neonates, arterial switch operation carries a low operative risk and provides excellent mid-term results; (2) The operative risk remains increased in some subsets; and (3) Some coronary patterns increase the risk of coronary events. Further surgical experience may improve the results.
确定新生儿动脉调转术后冠状动脉事件的发生率，并识别死亡和冠状动脉事件的潜在危险因素。
研究了一位外科医生的全部手术经验（连续236例动脉调转手术）。相关手术包括37例（16%）患者的室间隔缺损修补和14例（6%）患者的主动脉弓修复。分析了各种患者、手术、支持技术和经验变量的影响。
有19例死亡（8 - 70%可信区间 = 6 - 10%）。1个月、1年和5年的生存率分别为93%、92%和92%。死亡的危险因素包括低出生体重（P = 0.0015）、右心室发育不全（P < 0.0001）、主动脉弓梗阻（P < 0.0001）以及冠状动脉走行于两大动脉之间的冠状动脉形态（P = 0.0066）。26例患者发生冠状动脉事件（11 - 70%可信区间 = 9 - 13%），包括冠状动脉性死亡（11例）、非致命性心肌梗死（8例）和冠状动脉狭窄或闭塞（7例）。1个月、1年和5年无冠状动脉事件的发生率分别为94%、91%和88%。冠状动脉事件的危险因素包括左主干或左旋支冠状动脉走行于肺后、冠状动脉走行于两大动脉之间的冠状动脉形态（P < 0.0001）、壁内冠状动脉的所有变异（P = 0.0010）以及冠状动脉开口的连合部起源（P = 0.0171）。
（1）在大多数新生儿中，动脉调转手术的手术风险较低且中期效果良好；（2）某些亚组的手术风险仍然较高；（3）某些冠状动脉形态会增加冠状动脉事件的风险。进一步的手术经验可能会改善结果。
