单中心11年大动脉调转术早期死亡及远期再手术分析

Analysis of early death and long-term reoperation after 11-year single-center arterial switch operation

目的通过对大动脉调转术(ASO)患儿术后早期死亡和远期再手术分析,探讨ASO的手术风险和远期再手术原因。方法回顾性分析2010年1月至2020年12月在上海儿童医学中心接受ASO手术治疗的患儿的临床资料及在该时间段内的随访资料,分为室间隔完整型的大动脉转位(TGA/IVS)、大动脉转位合并室间隔缺损(TGA/VSD)、Taussig-Bing畸形(TBA)及二期ASO(Ⅱ-ASO)4组。采用χ^(2) 检验分析不同组别ASO术后的早期死亡比例、远期再手术率。结果本研究共纳入861例ASO手术患儿,术后早期死亡108例(12.5%)。753例术后随访,失访102例(13.5%,102/753)。651例完成随访,男352例,女299例,中位随访7.23(4.74,9.37)年。66例(10.1%,66/651)远期再手术治疗,4例(6%,4/66)再手术死亡。TGA/IVS 241例,再手术24例(10%);TGA/VSD 256例,再手术23例(9%);TBA 126例,再手术18例(14.3%);Ⅱ-ASO 28例,再手术1例(3.6%)。再手术原因包括:肺动脉扩大成形36例(死亡2例),肺动脉内支架置入2例,右心室流出道梗阻(RVOTO)纠治10例,主动脉瓣成形2例,主动脉瓣置换5例(死亡2例),主动脉吻合口狭窄纠治4例,左心室流出道梗阻(LVOTO)纠治3例,VSD残余分流修补2例,主动脉缩窄(CoA)纠治2例。结论ASO手术的早期死亡比例仍然偏高,较欧美发达国家还有一定差距。ASO术后的远期随访需关注肺动脉右心室流出道狭窄及主动脉瓣关闭不全。

Objective To analyze the early postoperative mortality and long-term reoperation of ASO and to explore the surgical risk and the reasons of long-term reoperation.Methods The clinical data and follow-up data of ASO children undergoing surgery in Shanghai Children Medical Center from January 2010 to December 2020 were analyzed retrospectively.Four groups were divided into transposition of the great vessels(TGA/IVS),transposition of the great vessels with ventricular septal defect(TGA/VSD),Taussig-bing anomaly(TBA),and two stage ASO(Ⅱ-ASO)groups.χ^(2) test was used to analyze the early mortality and long-term reoperation rates of ASO in different groups.Results A total of 861 ASO patients were included in this study and 108 died early(12.5%,108/861).Seven hundred and fifty three cases were followed up and 102 cases were lost(13.5%,102/753).The median follow-up time was 7.23 years and the quartile interval was 4.74-9.37 years old.Sixty six patients(10.1%,66/651)underwent long-term reoperation.Four patients(6%,4/66)died after reoperation.In 241 cases of TGA/IVS,24 cases(10%)were performed reoperation.In 256 cases of TGA/VSD,23 cases(9%)had reoperation.In 126 cases of TBA,18 cases(14.3%)for reoperation.And in 28 cases ofⅡ-ASO only 1 case(3.6%)had reoperation.Among all the reoperation cases,there were 36 cases(2 deaths)for pulmonary angioplasty,2 cases for pulmonary stenting,10 cases for right ventricular outflow tract obstruction(RVOTO)repair,2 cases for aortic valvularplasty,5 cases for aortic valve replacement(2 deaths),4 cases for aortic anastomotic stenosis repair,3 cases for left ventricular outflow tract obstruction(LVOTO)repair,2 cases for VSD residual shunt repair and 2 cases for coarctation of the aorta(CoA)correction.Conclusion The early mortality rate of ASO surgery is still higher than that of developed countries.Long-term follow-up after ASO surgery should focus on right ventricular outflow tract stenosis and aortic valve insufficiency.