大动脉调转术后新主动脉瓣关闭不全10年结果分析

New aortic valve regurgitation after arterial switch in D-TGA patients: ten years outcomes from Fuwai Hospital

目的 总结分析本院小儿心脏外科中心完全性大动脉转位患儿行大动脉调转术后发生新主动脉瓣返流的结果。方法 2006年4月至2016年9月,回顾性分析本院小儿心脏外科中心行大动脉调转术的完全性大动脉转位患者599例。2011年起,对出现主动脉和肺动脉直径严重不匹配的完全性大动脉转位患儿,本中心采用新的主动脉窦管交界成形技术,根据是否采用窦管交界成形技术分为两组,用倾向性配对方法每组选择各30名患者进行对比,对全部患者资料进行长期随访。结果 该组患儿远期生存率为93.3%(559/599),新主动脉瓣返流发生率6.5%(39/599),主动脉瓣置换发生率0.5%(3/599),既往肺动脉环缩术和主、肺动脉直径不匹配是发生严重主动脉瓣关闭不全的危险因素,对于主肺动脉直径不匹配患儿行新主动脉窦管交界成形术后未随访到重度主动脉瓣返流的发生。结论 本中心大动脉调转术治疗完全性大动脉转位患儿有着较低的主动脉瓣返流和主动脉瓣置换发生率,具有良好的远期效果。新主动脉瓣的返流与既往行肺动脉环缩术和主肺动脉直径不匹配相关。对于主肺动脉直径不匹配患儿使用新主动脉窦管交界成形术有可能降低新主动脉瓣返流的发生率。

Objective To report the results of new aortic regurgitation (NAR) after arterial switch operation for patients with d -trans-position of the great arteries (D-TGA). Methods From April 2006 to September 2016, 599 patients who underwent arterial switch operation for D-TGA were included in this retrospective study. Since 2011, concomitant new aortic sinotubular junction reconstruction was performed if the patients showed aorta and pulmonary artery discrepancy. 60 patients were divided into 2 groups by whether undergoing reconstruction was performed or not. Results The long-term survival rate was 93.3%(559/599) in patients with DTGA. The incidence of NAR was 6.5%(39/599) and the aortic valve replacement rate was 0.67%(4/599). Previous pulmonary artery banding, aortic and pulmonary artery diameter discrepancy were risk factors for significant NAR in this group of patients. After the application of new aortic sinotubular junction reconstruction, no significant NAR was recorded in patients with aortic and pulmonary artery discrepancy. Conclusion After the arterial switch operation, we reported a favorable incidence of NAR and rare new aortic valve replacement. Significant NAR was associated with aorta-pulmonary discrepancy and previous pulmonary artery banding. Patients with aortic and pulmonary artery diameter discrepancy might benefit from sinotubular junction reconstruction.