Abstract：
BACKGROUND: We hypothesized that preoperative patient characteristics and branch pulmonary artery (PA) size might influence the rate of postoperative branch PA reintervention in patients with transposition of the great arteries who undergo the arterial switch operation (ASO).
METHODS: The retrospective single-center study included 262 consecutive (2008-2017) newborns who underwent the ASO. Demographic characteristics, echocardiography, and clinical outcomes were reviewed. Competing risk analysis modeled incidence of branch PA reintervention and cause-specific hazard regression for predictors analyses.
RESULTS: Median age and weight were 7 (range, 5-11) days and 3.4 (range, 3.1-3.8) kg, respectively. Various types of early branch PA reinterventions (concomitant revision or reintervention during the intensive care unit stay) were required in 28 (10.7%) patients. These patients had prolonged ventilation (P < .001), intensive care unit duration (P < .001), worse right ventricular function (P = .043), and high in-hospital mortality (P = .010). Branch PA dimensions significantly decreased immediately after ASO compared with baseline measurements. The median follow-up duration was 20.8 (range, 0.9-44.7) months. Branch PA reintervention was common among survivors without early reinterventions (9.4%), and even more frequent among those with early reinterventions (25%). Subsequent reintervention (all catheter-based) was necessary for more than one-third of patients after initial branch PA reintervention. The multivariable analysis showed preoperative dimension of the left PA (hazard ratio, 0.527 [95% CI, 0.337-0.823]; P = .005), and right PA (hazard ratio, 0.503 [95% CI, 0.318-0.796]; P = .003) were independently associated with late branch PA reinterventions.
CONCLUSIONS: Branch PA reintervention was common and often required surgical or catheter-based reinterventions after ASO. PA branch diameters became significantly smaller after ASO. Smaller preoperative branch PA predicted late branch PA reintervention, indicating a smaller margin of geometrical tolerance to this effect.
METHODS: The retrospective single-center study included 262 consecutive (2008-2017) newborns who underwent the ASO. Demographic characteristics, echocardiography, and clinical outcomes were reviewed. Competing risk analysis modeled incidence of branch PA reintervention and cause-specific hazard regression for predictors analyses.
RESULTS: Median age and weight were 7 (range, 5-11) days and 3.4 (range, 3.1-3.8) kg, respectively. Various types of early branch PA reinterventions (concomitant revision or reintervention during the intensive care unit stay) were required in 28 (10.7%) patients. These patients had prolonged ventilation (P < .001), intensive care unit duration (P < .001), worse right ventricular function (P = .043), and high in-hospital mortality (P = .010). Branch PA dimensions significantly decreased immediately after ASO compared with baseline measurements. The median follow-up duration was 20.8 (range, 0.9-44.7) months. Branch PA reintervention was common among survivors without early reinterventions (9.4%), and even more frequent among those with early reinterventions (25%). Subsequent reintervention (all catheter-based) was necessary for more than one-third of patients after initial branch PA reintervention. The multivariable analysis showed preoperative dimension of the left PA (hazard ratio, 0.527 [95% CI, 0.337-0.823]; P = .005), and right PA (hazard ratio, 0.503 [95% CI, 0.318-0.796]; P = .003) were independently associated with late branch PA reinterventions.
CONCLUSIONS: Branch PA reintervention was common and often required surgical or catheter-based reinterventions after ASO. PA branch diameters became significantly smaller after ASO. Smaller preoperative branch PA predicted late branch PA reintervention, indicating a smaller margin of geometrical tolerance to this effect.
摘要：
背景：我们假设术前患者特征和分支肺动脉（PA）大小可能会影响大动脉转位患者接受动脉转换手术（ASO）的术后分支PA再干预率。
方法：回顾性单中心研究包括262名连续（2008-2017年）接受ASO的新生儿。人口特征，超声心动图,并对临床结果进行了回顾。竞争风险分析对分支PA再干预和特定原因风险回归的发生率进行建模，以进行预测分析。
结果：年龄和体重中位数为7（范围，5-11）天和3.4（范围，3.1-3.8)kg,分别。28例（10.7％）患者需要进行各种类型的早期分支PA再干预（在重症监护病房住院期间同时进行修正或再干预）。这些患者通气时间延长(P<.001),重症监护病房持续时间（P<.001），右心室功能较差（P=0.043），住院死亡率高（P=.010）。与基线测量相比，ASO后分支PA尺寸立即显着降低。中位随访时间为20.8（范围，0.9-44.7）个月。分支PA再干预在没有早期再干预的幸存者中很常见(9.4%)，在早期再干预者中更为频繁(25%)。在初次分支PA再干预后，超过三分之一的患者需要随后的再干预（全部基于导管）。多变量分析显示左侧PA的术前维度(风险比，0.527[95%CI，0.337-0.823]；P=.005)，和右PA(危险比，0.503[95%CI，0.318-0.796]；P=.003）与末梢分支PA再干预独立相关。
结论：分支PA再干预是常见的，在ASO后通常需要手术或基于导管的再干预。ASO后PA分支直径明显变小。较小的术前分支PA预测晚期分支PA再干预，表示此效果的几何公差余量较小。
方法：回顾性单中心研究包括262名连续（2008-2017年）接受ASO的新生儿。人口特征，超声心动图,并对临床结果进行了回顾。竞争风险分析对分支PA再干预和特定原因风险回归的发生率进行建模，以进行预测分析。
结果：年龄和体重中位数为7（范围，5-11）天和3.4（范围，3.1-3.8)kg,分别。28例（10.7％）患者需要进行各种类型的早期分支PA再干预（在重症监护病房住院期间同时进行修正或再干预）。这些患者通气时间延长(P<.001),重症监护病房持续时间（P<.001），右心室功能较差（P=0.043），住院死亡率高（P=.010）。与基线测量相比，ASO后分支PA尺寸立即显着降低。中位随访时间为20.8（范围，0.9-44.7）个月。分支PA再干预在没有早期再干预的幸存者中很常见(9.4%)，在早期再干预者中更为频繁(25%)。在初次分支PA再干预后，超过三分之一的患者需要随后的再干预（全部基于导管）。多变量分析显示左侧PA的术前维度(风险比，0.527[95%CI，0.337-0.823]；P=.005)，和右PA(危险比，0.503[95%CI，0.318-0.796]；P=.003）与末梢分支PA再干预独立相关。
结论：分支PA再干预是常见的，在ASO后通常需要手术或基于导管的再干预。ASO后PA分支直径明显变小。较小的术前分支PA预测晚期分支PA再干预，表示此效果的几何公差余量较小。
