完全型大动脉转位行大动脉调转术十年(2001～2012年)的变化趋势——单中心报告

Trends in Outcomes among Patients Undergoing Arterial Switch Procedure for D-Transposition of Great Arteries from a Single Center:2001-2012 Year

目的考察完全型大动脉转位行大动脉调转术术前因素以及住院死亡率10年的变化趋势。方法回顾性分析阜外医院2001~2012年连续473例完全型大动脉转位行大动脉调转术患者的临床资料。按照手术时间先后顺序,将所有患者分为6组(每2年1组),首先使用趋势分析的方法,对这些患者的术前因素及住院死亡率的变化趋势进行了分析;然后通过危险因素调整的方法,再次分析了住院死亡率的变化趋势。结果全组共有29例住院死亡,总体住院死亡率6.1%。所有术前因素包括年龄(P=0.13)、性别(P=0.94)、身高(P=0.29)、体重(P=0.21)、合并肺动脉高压(P=0.59)、行左心室训练(P=0.14)、冠状动脉异常分型(P=0.27)及合并非限制性室间隔缺损(P=0.14)未表现出显著的变化趋势。未经调整的住院死亡率在这10年间明显下降[17.4%(第1组)vs.4.1%(第6组),P<0.001]。经过术前因素调整后,住院死亡率亦表现出了明显下降(以第1组为参照,第6组的比值比:0.098,95%可信区间0.018-0.550,P=0.01)。结论在2001~2012年间,在术前因素没有显著变化的情况下,完全型大动脉转位行大动脉调转术的住院死亡率显著下降。

Objective To examine changes of in-hospitalization mortality for arterial switch operation(ASO) for the patients with D-transposition of the great arteries(TGA) in our hospital.Methods We retrospectively analyzed the clinical data of 473 consecutive TGA patients undergoing ASO to assess temporal trends of in-hospital mortality between 2001 and 2012 year.The patients in every 2 years were brought together into a group.By this way,all the patients were divided into 6 groups.In risk-adjusted analyses,mortality of each group between 2001 and 2012 year were compared within the 6 groups.Results Among all the patients,29 in-hospital deaths occurred.Between 2001 and 2012 year,the prevalence of preoperative factors-including age(P=0.13),gender(P=0.94),height(P=0.29),weight(P=0.21),combined with pulmonary hypertension(P=0.59),training for left ventricle(P=0.14),and anatomy of coronary arteries(P=0.27) did not significantly change.Crude mortality significantly decreased during that period(17.4% in the first group vs.4.1% in the sixth group,P<0.001).Adjusted mortality also significantly became better in the ten years(the sixth group vs.the first group,odds ratio 0.098,95% confidence interval,0.018-0.550,P=0.01).Conclusions Between 2001 and 2012 year,the prevalence of risk factors among TGA patients undergoing ASO remains unchanged,but the in-hospital mortality substantial decreases.