The Role of Cardiac Resynchronization Therapy for Arterial Switch Operations Complicated by Complete Heart Block
The Role of Cardiac Resynchronization Therapy for Arterial Switch Operations Complicated by Complete Heart Block
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DOI：
10.1016/j.athoracsur.2013.05.082
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发表时间：
2013-09-01
影响因子：
4.6
通讯作者：
Cecchin, Frank
中科院分区：
文献类型：
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作者：
Mah, Douglas Y.;Alexander, Mark E.;Cecchin, Frank
背景由于大动脉转位（D-TGA）患者的死亡率在动脉调转手术（阿索）后有所下降，重点已转移到影响长期发病率和死亡率的高风险组和结局，如左心室（LV）功能障碍。我们试图研究与D-TGA和室间隔缺损（VSD）患者ASO术后左室功能障碍相关的围手术期因素。回顾性研究了2001年至2011年接受阿索/VSD闭合术的所有D-TGA/VSD患者。排除了早产、L型环心室和骑跨房室瓣的患者。主要终点是术后2个月或更长时间超声心动图测量的中度或重度左室功能不全。共有112例患者在中位年龄5天时接受阿索/VSD闭合术。中位随访时间为6.5个月，未观察到死亡。6例患者（8%）至少有中度LV功能障碍。危险因素是需要放置起搏器的心脏传导阻滞（p < 0.001）和入住重症监护室的时间（p = 0.04）。所有6例心脏传导阻滞患者均在右心室游离壁植入了心外膜电极导线; 4例有中度或重度左心室功能不全，并接受了心脏起搏治疗（CRT）;从初始起搏器到CRT的中位时间为5个月。CRT术后中位随访5个月，左室功能恢复正常（2例）或轻度功能障碍（2例）。D-TGA/VSD手术修复后的左心室功能障碍较低，心脏传导阻滞和起搏器植入起着重要作用。患者升级至CRT器械后，左室功能改善。(C)2013年由胸外科医师协会
Background. As mortality in patients with D-loop transposition of the great arteries (D-TGA) has decreased after the arterial switch operation (ASO), the focus has shifted to higher risk groups and outcomes that impact long-term morbidity and mortality, such as left ventricular (LV) dysfunction. We sought to examine the perioperative factors associated with LV dysfunction in patients with D-TGA and ventricular septal defects (VSD) after ASO.Methods. A retrospective study was made of all patients with D-TGA/VSD who underwent ASO/VSD closure from 2001 to 2011. Patients with prematurity, L-looped ventricles, and straddling atrioventricular valves were excluded. The primary endpoint was moderate or severe LV dysfunction measured by echocardiogram 2 months or more after surgery.Results. A total of 112 patients underwent ASO/VSD closure at a median age of 5 days. Median time of follow-up was 6.5 months, with no mortality noted. Six patients (8%) were noted to have at least moderate LV dysfunction. Risk factors were heart block requiring pacemaker placement (p < 0.001) and length of intensive care unit admission (p = 0.04). All 6 patients with heart block had an epicardial lead on the right ventricular free wall; 4 had moderate or severe LV dysfunction and underwent upgrade to cardiac resynchronization therapy (CRT); median time from initial pacemaker to CRT was 5 months. With a median follow-up of 5 months after CRT, LV function improved to normal (2 patients) or mild dysfunction (2 patients).Conclusions. Left ventricular dysfunction after surgical repair for D-TGA/VSD is low, with heart block and pacemaker insertion playing a significant role. The LV function improved after patients were upgraded to a CRT device. (C) 2013 by The Society of Thoracic Surgeons