Intermediate outcome after Mustard and Senning procedures: A study by the Congenital Heart Surgeons Society.
Intermediate outcome after Mustard and Senning procedures: A study by the Congenital Heart Surgeons Society.
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Mustard 和 Senning 手术后的中期结果：先天性心脏病外科医生协会的一项研究。
DOI：
10.1053/tc.2000.6043
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发表时间：
2000
期刊：
影响因子：
--
通讯作者：
E. Blackstone
中科院分区：
文献类型：
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作者：
W. Wells;E. Blackstone
虽然心房转换术除了作为“双转换”手术的一部分外，今天很少进行，但由于许多Mustard和Senning幸存者正在随访，因此对该手术的长期结果仍然感兴趣。与大多数其他报道的心房转换系列研究相反，先天性心脏外科医生协会（CHSS）的这项研究是一项前瞻性多机构研究，研究对象是20世纪80年代末在相对较短的时间内遇到的患者。在1985年至1989年期间，20个中心的外科医生属于CHSS前瞻性登记的患者<15天的年龄表现为简单或复杂的大动脉转位（TGA）。根据意向治疗（动脉转换、Mustard或Senning）将患者分配至方案组。在数据和分析中心提取数据，在大多数情况下，数据和分析中心进行年度随访。在281例接受心房转换术的患者中，有108例接受了Mustard手术，173例接受了Senning手术。对于合并的心房转换人群，1个月、5年和10年的生存率分别为90%、85%和84%。Mustard的结果优于Senning，1个月、5年和10年的生存率分别为96%和86%、95%和80%、93%和78%（P <.001）。虽然两组的主要死亡风险发生在术后第一个月，此后，术后1至10年的晚期死亡率为0.78%/年，Senning组为0.23%/年，Mustard组为0.05。TGA/室间隔缺损（VSD）、较低体重、年轻、心脏位置异常和左心室（LV）流出道手术均与不良结局显著相关。有19例再次手术，包括2例右心室（RV）衰竭，12例通路阻塞，5例挡板泄漏，总死亡率为36%。10年时无任何通路阻塞率为95%。21例具有显著风险因素（包括TGA/VSD和Senning以及既往房间隔切除术）的患者需要永久性起搏器。10年时无起搏器植入率为91%。对于Mustard和Senning，60%的患者为纽约心脏协会（NYHA）功能I级，其余为II级。CHSS对心房转换结局的研究表明，接受Mustard手术的亚组的早期和晚期生存率均优于接受Senning手术的亚组。尽管因该并发症进行再手术的风险较高，但挡板通道阻塞的总体发生率较低。需要药物治疗的严重心律失常和需要永久性起搏器都相对罕见。严重右心衰竭的发生率非常低，尽管只有60%的患者活动不受限制。版权所有2000 W.B.桑德斯公司
Although atrial switch is rarely performed today except as part of a "double switch" operation, there continues to be interest in the long-term outcome of the procedure because of the many Mustard and Senning survivors who are in follow-up. In contrast to most other reported series on atrial switch, this study by the Congenital Heart Surgeons Society (CHSS) is a prospective multiinstitutional study of patients encountered in a relatively short time frame during the late 1980s. Between 1985 to 1989, 20 centers with surgeons belonging to the CHSS prospectively registered patients <15 days of age presenting with simple or complex transposition of the great arteries (TGA). The patients were assigned to protocol groups based on intent to treat (arterial switch, Mustard, or Senning). Data were abstracted in the Data and Analysis Center, which in most cases, conducted the annual follow-up. Among the 281 patients who had an atrial switch, there were 108 Mustard and 173 Senning procedures. For the combined atrial switch population, the survival at 1 month, 5 years and 10 years was 90%, 85%, and 84%, respectively. Results for the Mustard were better than for the Senning with survival at 1 month, 5 years, and 10 years being 96% versus 86%, 95% versus 80%, 93% versus 78%; (P <.001) for Mustard versus Senning. While the major mortality risk occurred in the first postoperative month for both groups, thereafter, the late rate of death from 1 to 10 years after operation was 0.78%/year Senning versus 0.23%/year Mustard (P <.05). TGA/ventricular septal defect (VSD), lower weight, younger age, cardiac positional anomalies, and procedures on the left ventricle (LV) outflow all correlated significantly with poor outcome. There were 19 reoperations including 2 for right ventricle (RV) failure, 12 for pathway obstruction, and 5 for baffle leak with a 36% overall mortality. Freedom from any pathway obstruction at 10 years was 95%. A permanent pacemaker was required in 21 patients with the significant risk factors including TGA/VSD and a Senning, and previous atrial septectomy. Freedom from a pacemaker insertion at 10 years was 91%. For both Mustard and Senning, 60% of patients were in New York Heart Association (NYHA) functional Class I with the remaining in Class II. This study of atrial switch outcomes by the CHSS suggests that the subgroup undergoing a Mustard procedure had better early and late survival than those undergoing a Senning operation. The overall incidence of baffle pathway obstruction was low though reoperation for this complication carried high risk. Serious arrhythmia requiring medication and the need for a permanent pacemaker were both relatively uncommon. The incidence of severe right heart failure was very low, although only 60% of patients are unrestricted in their activity. Copyright 2000 by W.B. Saunders Company