Outcome of the Norwood procedure in the setting of transposition of the great arteries and functional single left ventricle
Outcome of the Norwood procedure in the setting of transposition of the great arteries and functional single left ventricle
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DOI：
10.1016/j.ejcts.2008.09.016
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发表时间：
2009-01-01
影响因子：
3.4
通讯作者：
Brawn, William J.
中科院分区：
文献类型：
--
作者：
Lotto, Attilio A.;Hosein, Riad;Brawn, William J.
目的：评估诺伍德手术的手术结果和随后的大动脉转位（TGA）伴优势形态左心室的临床结局。研究方法：在1988年至2007年在我院接受诺伍德手术的486例患者中，有37例患者患有TGA和左心室依赖性循环，并伴有以下病变：左心室双入口（DILV）（n = 24），三尖瓣闭锁（n = 9），室间隔缺损（VSD）伴右心室发育不良（RV）（n = 4）。将所有三阶段手术的结果与整个诺伍德组进行比较。结果：早期死亡率为21.6%（8/37），而整个诺伍德组为26.7%（120/449）（p = ns）。仅发生1例后续死亡，5年和10年精算生存率为72.8 +/- 7.4%，而总体系列的5年和10年精算生存率分别为55.3 +/- 2.6%和52 +/- 2.9%（p = 0.06）。中位随访时间为4.7（0.7-10.2）年。18例患者在第二阶段3.9 +/- 1.5年时完成III期手术，无死亡。术前平均肺动脉（PA）压和跨肺动脉压差分别为11.6 +/- 3.4和5.2 +/- 3.3 mmHg。所有患者在III期时左心室（W）功能良好。除1例患者外，所有患者目前均处于NYHA I级。1例患者（DILV）患有先天性心脏传导阻滞，需要植入起搏器。术后无心传导阻滞。所有患者的体循环流出通畅，没有患者需要任何额外的心内手术。结论：诺伍德手术为该亚组患者提供了良好的姑息治疗，避免了后续心内手术的需要，保持了体循环流出道通畅，避免了术后心脏传导阻滞的风险。(C)2008年欧洲胸外科协会。Elsevier B. V.出版，保留所有权利。
Objective: To assess the surgical results of the Norwood procedure and subsequent clinical outcome in the setting of transposition of the great arteries (TGA) with a dominant morphologic left ventricle. Methods: Among 486 patients who underwent the Norwood procedure from 1988 to 2007 at our institution, there were 37 patients with TGA and left ventricular dependant circulation with the following associated lesions: double inlet left ventricle (DILV) (n = 24), tricuspid atresia (n = 9), ventricular septal defect (VSD) with hypoplastic right ventricle (RV) (n = 4). Outcomes for all three-staged procedure were compared with the overall Norwood group. Results: Early mortality was 21.6% (8/37) compared to 26.7% (120/449) in the overall Norwood group (p = ns). There was only one subsequent death giving a 5- and 10-year actuarial survival of 72.8 +/- 7.4% compared to 55.3 +/- 2.6% and 52 +/- 2.9% at 5 and 10 years for the overall series (p = 0.06). Median follow-up was 4.7 (0.7-10.2) years. Eighteen patients underwent stage III completion at 3.9 +/- 1.5 years from the second stage with no mortality. Preoperative mean pulmonary artery (PA) pressure and transpulmonary gradient were respectively 11.6 +/- 3.4 and 5.2 +/- 3.3 mmHg. All patients had good left ventricle (W) function at time of stage III. All patients except one are currently in NYHA I. One patient (with DILV) had congenital heart block and required a pacemaker. There was no postoperative heart block. The systemic outflow was unobstructed in all patients and no patient required any additional intracardiac procedure. Conclusions: The Norwood procedure provides good palliation in this subgroup of patients and avoids the need for subsequent intracardiac operations, maintaining unobstructed systemic outflow tract and avoiding the risk of postoperative heart block. (C) 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.