矫正型大动脉转位手术治疗中期结果分析

本文在2009亚洲胸心血管外科医生年会宣讲

花中东，胡盛寿，潘湘滨，沈向东，李守军，阎军，刘迎龙，吴清玉，王旭

 

摘要

目的：报告并分析阜外心血管病医院107例手术治疗矫正型大动脉转位(CTGA)合并心内畸形患者的远期随访结果。北京阜外医院小儿心脏外科花中东

方法：1996-01至2OO5-12，在我院手术治疗CTGA合并心内畸形患者107例，其中男72例，女35例；年龄1.5～50岁，平均（11.5+8.4）岁；平均体重（31.6+4.7）kg。81例左位心，23例右位心，3例中位心。手术方式包括传统双心室功能矫治75例；单心室分期矫治14例；双心室解剖矫治18例。

结果：术后早期死亡5例，死亡率为4.7%。单心室分期矫治死亡率为0%；传统双心室功能矫治死亡率为4.0%；心房动脉双调转手术死亡率为0%;心房心室双调转手术死亡率40.0%。手术死亡危险因素为复杂心内畸形合并肺动脉瓣狭窄（P<0.01），Rastelli手术方法(P<0.05)，差异有统计学意义。共随访99例，随访率为92.5%。随访期间死亡12例，死亡率为12.6% ，其中10例（83.3%）属于传统双心室功能矫治患者；2例（16.7%）属于单心室矫治患者；双心室解剖矫治患者没有死亡。随访期死亡危险因素为传统功能矫治手术方式(P<0.001)，Rastelli手术(P<0.05)，术后三尖瓣关闭不全(P<0.05)，差异有统计学意义。

结论：CTGA传统手术方法的中期结果是令人失望的。对于适合单心室矫治的CTGA病例，手术可以取得较好的近期和中期结果。心房动脉双调转手术近期和中期的死亡率低，并发症少，其手术结果是值得肯定的。

 

Operative and Long-Term Results of 107 Congenitally Corrected Transposion of Great Artery

HUA Zhong-dong, HU Sheng-shou,  PAN Xiang-bing, SHEN Xiang-dong, LI Shou-jun, YAN Jun, LIU Ying-long, WU Qing-yu, WANG Xu.

Center of Pediatric Cardiac Surgery, Cardiovascular Institute and Fu Wai Hospital, CAMS and PUMC, Beijing (100037), China

Corresponding Author: Hua Zhong-dong, Email: [e-mail]

        

Abstract

Objective: To retrospectively analyze the results and mid-term outcomes of 107 patients with corrected congenital transposition of great arteries (CCTGA) who underwnet surgical treatment in Fuwai Hospital.

Methods: A total of 107 CCTGA patients with surgical treatment from 1996 to 2005 in our hospital were studied.  There were 72 male and 35 female, with the mean age of 11.5 years and mean body weight of 31kg. Among the cohort, 81 were levocardia, 23 dextrocardia, 3 medocardia.  Initial surgical procedure included single ventricle repair in 14 patients, conventional biventricular repair in 75, double switch in 17 patients, and senning and nikadoh in 1 patient. 93% patients were followed-up with the mean time of 47.8 months.

Results: Operative mortality rate was 4.76% in different procures, with single ventricle repair 0%, conventional biventricular repair 4%, atrial-arterial double switch 0%, atrial-ventricular double switch 40%.  The risk factors for operative mortality were lesions with double outlet left ventricle combined with pulmonary stenosis(P<0.01),and Rastelli procedure (P<0.05). 12 patients(12.6%) died during follow-up period, among them 10(83.3%) were in conventional repair group, 2 (16.7%) in single ventricle repair group, no death in double switch group. The risk factors for follow-up death were conventional biventricular repair, Rastelli procedure and tricuspid regurgitation.

Conclusion: Conventional biventricular repair had a disappointing outcome in both operative procedure and long-term follow-up period. Patients suitable for single ventricular repair had fair short- and med-term outcomes. Atrial-arterial double switch procedure had good operative and long-term results.

 

Key words  Corrected congenital transposition of great arteries; Cardiac surgery