不同时期行大动脉调转术对并室间隔缺损的完全性大动脉转位患儿预后的影响

Impact of Surgical Timing on Outcomes Following Primary Arterial Switch Operation in Infants with Transposition of Great Arteries Combined with Ventricular Septal Defect

目的评价大动脉调转术(ASO)手术时机对并室间隔缺损的完全性大动脉转位(TGA/VSD)患儿预后的影响。方法选取2005年1月-2009年12月在本院行ASO的TGA/VSD患儿62例,依手术时年龄分为早期组(≤28 d)30例,手术年龄4～28(15.00±6.56)d;晚期组(>28 d)32例,手术年龄29～186(58.00±30.54)d。回顾性分析各组术后围术期并发症、早期死亡、中期死亡及再次手术干预等情况。结果二组术后低心排、肺动脉狭窄、心律失常、膈肌麻痹、呼吸道异常、肾衰竭等并发症发生率差异无统计学意义。早期组早期死亡5例,其中死于低心排综合征3例,死于肾衰竭和心脏骤停各1例;晚期组早期死亡1例,死亡原因为低心排综合征。二组早期病死率分别为16.7%(5/30例)和3.1%(1/32例),其差异无统计学意义(P=0.200),二组的主要早期死亡原因均为术后低心排综合征。随访56例出院患儿,随访率91.1%(51/56例),随访时间中位数为35个月(13～71个月)。早期组无需再次干预病例,晚期组2例因术后肺动脉狭窄需再次手术干预,二组比较差异无统计学意义(P=1.000)。早期组无中期死亡,晚期组中期病死率为6.5%(2/31例),二组比较差异无统计学意义(P=1.000)。结论 TGA/VSD患儿术后早期及中期预后好。手术年龄不是TGA/VSD手术时机的决定性因素,术后低心排综合征是TGA/VSD的主要早期死亡原因,术前充分评估,改善术前状态有利于选择良好的手术时机。

Objective To access the impact of surgical timing on outcomes following primary arterial switch operation（ASO） in infants of complete transposition of great arteries combined with ventricular septal defect（TGA/VSD）. Methods In this retrospective study,62 con- secutive patients with TGA/VSD underwent primary ASO between Jan. 2005 and Dec. 2009 were involved. They were divided into 2 groups ac- cording to the surgical age. Group early was for surgical age within day of life 28, group late was for day of life beyond 28. There were 30 cases in group early,the age at operation was 4 -28 （5.00 ± 6.56 ） d. There were 32 infants in group late, the age at operation was 29 - 186 （58.00 ± 30.54） d. Pre - operative complications, early mortality, mid - term mortality and re - intervention were analyzed retrospectively. Results There were no significant differences in low cardiac output syndrome, pulmonary stenosis, cardiac arrhythmia, diaphragmatic paralysis, airway abnormalities and renal failure. There was no statistical difference in early mortality （ P = 0.200）. There were 5 early deaths in group early. Three patients died from post - operative low cardiac output, 1 case died from renal failure, and 1 case died from cardiac arrest. There was 1 early death in group late,death cause was post -operative low cardiac output. Early mortality was 16.7% （5/30 cases）and 3.1% （1/32 cases）in group early and group late, respectively. Major cause of early death was post - operative low cardiac output in both groups. Of 56 infants survived after operation,follow - up data were available for 91.1% （51/56 cases） infants. Median follow - up time was 35 months（ 13 -71 months）. There was no re - intervention in group early, 2 patients in group need re - operation because of post-operative pulmonary stenosis. There was no significant difference in re - intervention rate between the 2 groups （ P = 1. 000 ）. There was no mid - term death in group early, but 6.5 % （2/31 cases） in group late. There was no significant difference of them （ P = 1. 000）. Conclusions Early and mid - term outcome is good in infants with TGA/VSD following ASO. Age is not the key factor for surgical timing in infants with TGA/VSD. Post - operative low cardiac output is the major cause of death in infants with TGA/VSD. Satisfactory pre - operative assessment, improving pro - operative status are of help to select optimal surgical timing.