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Abstract：
Background The aim of this study was to evaluate long-term survival and freedom from coronary artery reintervention after the arterial switch operation (ASO). Methods and Results This single-center nationwide retrospective study included consecutive children who underwent ASO between 1990 and 2016 (n=605). Long-term outcomes were obtained by cross-mapping individual data with the National Death Registry and the National Registry of Cardiovascular Interventions for adults. A control group was randomly retrieved at a 1:10 ratio from the National Birth and Death Registries. Early mortality was 3.3% and late mortality was 1.7% during a median follow-up of 10 (interquartile range, 5-16) years. The probability of overall survival at 20 years after ASO was 94.9% compared with 99.5% in the background population (hazard ratio [HR] 15.6; 95% CI, 8.9-27.5, P<0.001). Independent multivariable predictors of worse survival were an intramural coronary artery (HR, 5.2; 95% CI, 1.8-15.2, P=0.002) and period of ASO 1990 to 1999 (HR, 4.6; 95% CI, 1.5-13.6, P<0.001). Fourteen patients (2.3%) required 16 coronary artery reoperations. Freedom from coronary artery reintervention at 20 years after ASO was 96%. The only independent multivariable predictor associated with a higher hazard for coronary artery reintervention was an intramural coronary artery (HR, 33.9; 95% CI, 11.8-97.5, P<0.001). Conclusions Long-term survival after ASO is excellent. Coronary artery reinterventions are rare. An intramural coronary artery was an independent predictor associated with a higher risk for coronary artery reintervention and death, regardless of the surgical period.
摘要：
背景这项研究的目的是评估动脉转换手术（ASO）后的长期生存和冠状动脉再介入的自由度。方法和结果这项全国性的单中心回顾性研究包括1990年至2016年接受ASO的连续儿童（n=605）。通过与国家死亡登记处和国家成人心血管干预登记处交叉映射个体数据获得长期结果。从国家出生和死亡登记处以1：10的比例随机检索对照组。在中位随访10次期间，早期死亡率为3.3%，晚期死亡率为1.7%(四分位距，5-16）年。ASO后20年总生存率为94.9%，而背景人群为99.5%（风险比[HR]15.6；95%CI，8.9-27.5，P<0.001）。生存率较差的独立多变量预测因素是壁内冠状动脉（HR，5.2；95%CI，1.8-15.2，P=0.002)和1990年至1999年ASO期间(HR，4.6；95%CI，1.5-13.6，P<0.001）。14例患者（2.3％）需要16例冠状动脉再次手术。ASO后20年冠状动脉再介入的自由度为96％。与冠状动脉再介入的较高风险相关的唯一独立多变量预测因子是壁内冠状动脉（HR，33.9；95%CI，11.8-97.5，P<0.001）。结论ASO术后长期生存良好。冠状动脉再介入治疗是罕见的。壁冠状动脉是冠状动脉再介入和死亡风险较高的独立预测因子。不管手术时间。
