Late Results of Half-Turned Truncal Switch Operation for Transposition of the Great Arteries
Late Results of Half-Turned Truncal Switch Operation for Transposition of the Great Arteries
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DOI：
10.1016/j.athoracsur.2018.06.021
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发表时间：
2018-11-01
影响因子：
4.6
通讯作者：
Yaku, Hitoshi
中科院分区：
文献类型：
--
作者：
Hongu, Hisayuki;Yamagishi, Masaaki;Yaku, Hitoshi
背景资料。传统的Rastelli、Leccompte和Nikaidoh手术被认为是治疗完全性大动脉转位(TGA)伴左室流出道(LVOT)梗阻的标准技术。然而，这些手术显示出严重的缺点，包括术后双侧脑室流出道梗阻。为了解决这些问题，我们提出了半转向干线开关手术(HTTSO)。2002至2017年间，14名患者接受了HTTSO。中位年龄1.2岁，中位体重8.3公斤。诊断为TGA合并肺动脉狭窄9例，TGA型右室双出口4例，TGA合并肺动脉环扎术后肺动脉瓣退行性变1例。冠状动脉为YacoubA型13例，D型1例。肺动脉-主动脉环直径比为0.43~1.00。8例采用单瓣聚四氟乙烯瓣膜补片扩大右室流出道。6例保留了自体肺环。中位随访期为5.2年。无早期死亡病例。HTTSO术后11个月，仅1例因心律失常失血。没有患者表现出冠状动脉功能不全，也没有发现流出道阻塞。12例主动脉瓣返流程度在轻度以内。3例中重度二尖瓣关闭不全患者在HTTSO术后晚期需行二尖瓣环成形术。晚期死亡和再次手术的危险因素为低年龄和HTTSO时体重。HTTSO对合并左心室流出道梗阻的TGA非常有用，可确保宽而直的室流出道和生长潜力。(C)2018年，由胸外科医生学会主办
Background. Conventional Rastelli, Lecompte, and Nikaidoh operations are accepted as standard techniques for complete transposition of the great arteries (TGA) with left ventricular outflow tract (LVOT) obstruction. These operations show serious drawbacks, however, including postoperative obstruction of both ventricular outflow tracts. We developed the half-turned truncal switch operation (HTTSO) to address these problems.Methods. Between 2002 and 2017, 14 patients underwent HTTSO. Median age was 1.2 years and median body weight was 8.3 kg. Diagnosis was TGA with pulmonary stenosis in 9 cases, TGA-type double-outlet right ventricle in 4, and TGA with degenerative pulmonary valve after pulmonary arterial banding in 1. The coronary artery was Yacoub type A in 13 and type D in 1. Four patients had a small right ventricle. Pulmonary-aortic annular diameter ratio ranged from 0.43 to 1.00. The right ventricular outflow tract was augmented using a monocuspid polytetrafluoroethylene valved patch in 8 cases. Autologous pulmonary annulus was preserved in 6 cases.Results. Median follow-up was 5.2 years. No early mortality was encountered. Only 1 patient was lost due to arrhythmia, 11 months after HTTSO. No patients showed coronary insufficiency and no outflow tract obstruction was identified. Aortic regurgitation was within mild degree in 12 cases. Additional mitral valvular annuloplasty was required in 3 cases late after HTTSO for moderate-to-severe mitral regurgitation. Risk factors for late death and reoperation were low age and body weight at HTTSO.Conclusions. HTTSO is useful for TGA with LVOT obstruction, ensuring wide, straight ventricular outflow tracts and growth potential. (C) 2018 by The Society of Thoracic Surgeons