Abstract：
To identify risk factors associated with mortality and reintervention on primary arterial switch operation for Taussig-Bing anomaly in 225 cases over a 16-year period. From 2002 to 2017, 225 children with Taussig-Bing anomaly received a primary arterial switch operation at the Shanghai Children\'s Medical Center. Perioperative data and follow-up results were collected. Univariate and multivariable analysis was used to explore risk factors associated with early mortality. The competing risk analysis was used to identify risk factors related to reintervention. Early mortality was 12.9% (29/225) with a satisfactory long-term survival rate (10-year survival rate 85.0%). The median age at repair was 77 days (interquartile range, IQR, 48-139). The median duration of follow-up was 4.6 (range 0.1-18.3) years. 87 children (38.7%) received concomitant aortic arch repair. Prolonged cardiopulmonary bypass time (a-OR 1.18, 95% confidence interval [CI], 1.09-1.28, p < 0.001) is found to be an independent risk factor for early death. Larger weight at repair tends to be a protective factor (a-OR 0.66, 95% CI, 0.425-1.02, p = 0.060) and intramural coronary artery (a-OR 4.81, 95% CI, 0.927-24.9, p = 0.062) tends to be a risk factor for early mortality. The cumulative incidence rate of overall reintervention was 18.9% (95% CI, 10.3%-27.4%) at 5 years and 32.3% (95% CI, 17,0%-47.6%) at 10 years. No independent risk factors were identified for long-term overall reintervention. Prolonged aortic-cross clamp time was an independent risk factor for long-term right-sided reintervention (adjusted hazard ratio [a-HR] 1.12, 95% CI 1.005-1.25, p = 0.041). Neo-aortic regurgitation was a concern with an incidence rate of moderate or greater neo-AR of 16.1 % (95% CI 7.6%-24.7%) at 10 years. Intramural coronary artery remains a surgical challenge in primary arterial switch operation for the Taussig-Bing anomaly. Larger weight at ASO tends to be a protective factor for early death. Reintervention is frequently necessary but can be performed with satisfactory results.
摘要：
在16年的时间内，对225例Taussig-Bing异常的原发性动脉转换手术，确定与死亡率和再干预相关的危险因素。从2002年到2017年，在上海儿童医学中心接受了225例Taussig-Bing异常的初级动脉转换手术。收集围手术期资料及随访结果。采用单因素和多因素分析探讨与早期死亡相关的危险因素。竞争风险分析用于识别与再干预相关的风险因素。早期死亡率为12.9％（29/225），长期生存率令人满意（10年生存率85.0％）。修复时的中位年龄为77天(四分位距，IQR,48-139）。中位随访时间为4.6年（范围0.1-18.3年）。87名儿童（38.7％）同时接受了主动脉弓修复术。延长体外循环时间(a-OR1.18，95%置信区间[CI]，1.09-1.28，p<0.001）被发现是早期死亡的独立危险因素。较大的修复体重往往是保护因素（a-OR0.66，95％CI，0.425-1.02，p=0.060），壁内冠状动脉（a-OR4.81，95％CI，0.927-24.9，p=0.062）往往是早期死亡的危险因素。5年总再干预的累积发生率为18.9%（95%CI，10.3%-27.4%），10年为32.3%（95%CI，17.0%-47.6%）。没有发现长期整体再干预的独立危险因素。延长的主动脉阻断时间是长期右侧再干预的独立危险因素(调整后的风险比[a-HR]1.12,95%CI1.005-1.25,p=0.041)。新主动脉瓣反流是一个值得关注的问题，10年时中度或更高的新AR的发生率为16.1%(95%CI7.6%-24.7%)。在Taussig-Bing异常的初级动脉转换手术中，壁内冠状动脉仍然是手术挑战。ASO时体重较大往往是早期死亡的保护因素。再干预通常是必要的，但可以以令人满意的结果进行。
