Abstract：
OBJECTIVE: The purpose of this study was to evaluate our institution\'s 16-year arterial switch operation (ASO) experience and to determine early and late mortality and late morbidity, as well as the need for reoperation and catheter intervention, and finally, to explore risk factors for late complications and reintervention.
METHODS: The clinical data of 185 transposition of the great arteries (TGA) patients who received ASO treatment in our center from January 2006 to January 2022 were continuously included for retrospective study.
RESULTS: There were 13 early deaths (7.03%), 5 late deaths (3.01%), and 6 lost to follow-up. The median follow-up time for the 166 hospitalized survivors was 88.5 (2190) months. Moderate or above new aortic valve regurgitation (NAR; in this article, NAR represents moderate or greater reflux unless otherwise specified) occurred in 19 cases (11.45%), and aortic root dilation (ARD) occurred in 28 cases (16.87%). Late right ventricular outflow tract obstruction (RVOTO) occurred in 33 cases (19.88%). There were 18 patients (10.84%) who underwent late re-intervention, and the most common indication for intervention was RVOTO, followed by recurrent aortic coarctation in patients undergoing concurrent arch repair and NAR or ARD. Receiver operating characteristics analysis found that NAR had the strongest predictive power for ARD, followed by RVOTO, followed by bicuspid native pulmonary valve (BPV), and aorto-pulmonary diameter mismatch (APDMM) was the weakest. Multivariate analysis showed that APDMM, previous pulmonary artery banding (PAB), and mild NAR at discharge were independent risk factors for late NAR and ARD. Low surgical weight was an independent risk factor specific to NAR, and BPV was an independent risk factor specific to ARD. Older surgical age and ARD were independent risk factors for late RVOTO. Older surgical age, operation before 2014, late RVOTO, and late ARD were independent risk factors for late intervention. No reintervention events for coronary dysfunction were found in the late stage, but one patient occurred myocardial infarction due to coronary embolism after reoperation.
CONCLUSIONS: Early and late survival rates after ASO in TGA patients have been remarkably improved in recent decades. Increased rates of NAR, ARD, recurrent coarctation of the aorta, and RVOTO as children age are major future outcomes of concern and may imply more late reinterventions. Careful follow-up of neo-aortic valve and root function is imperative, especially in patients with APDMM, previous PAB, mild NAR at discharge, low surgical weight, and BPV structures.
METHODS: The clinical data of 185 transposition of the great arteries (TGA) patients who received ASO treatment in our center from January 2006 to January 2022 were continuously included for retrospective study.
RESULTS: There were 13 early deaths (7.03%), 5 late deaths (3.01%), and 6 lost to follow-up. The median follow-up time for the 166 hospitalized survivors was 88.5 (2190) months. Moderate or above new aortic valve regurgitation (NAR; in this article, NAR represents moderate or greater reflux unless otherwise specified) occurred in 19 cases (11.45%), and aortic root dilation (ARD) occurred in 28 cases (16.87%). Late right ventricular outflow tract obstruction (RVOTO) occurred in 33 cases (19.88%). There were 18 patients (10.84%) who underwent late re-intervention, and the most common indication for intervention was RVOTO, followed by recurrent aortic coarctation in patients undergoing concurrent arch repair and NAR or ARD. Receiver operating characteristics analysis found that NAR had the strongest predictive power for ARD, followed by RVOTO, followed by bicuspid native pulmonary valve (BPV), and aorto-pulmonary diameter mismatch (APDMM) was the weakest. Multivariate analysis showed that APDMM, previous pulmonary artery banding (PAB), and mild NAR at discharge were independent risk factors for late NAR and ARD. Low surgical weight was an independent risk factor specific to NAR, and BPV was an independent risk factor specific to ARD. Older surgical age and ARD were independent risk factors for late RVOTO. Older surgical age, operation before 2014, late RVOTO, and late ARD were independent risk factors for late intervention. No reintervention events for coronary dysfunction were found in the late stage, but one patient occurred myocardial infarction due to coronary embolism after reoperation.
CONCLUSIONS: Early and late survival rates after ASO in TGA patients have been remarkably improved in recent decades. Increased rates of NAR, ARD, recurrent coarctation of the aorta, and RVOTO as children age are major future outcomes of concern and may imply more late reinterventions. Careful follow-up of neo-aortic valve and root function is imperative, especially in patients with APDMM, previous PAB, mild NAR at discharge, low surgical weight, and BPV structures.
摘要：
目的：这项研究的目的是评估我们机构的16年动脉转换手术（ASO）的经验，并确定早期和晚期死亡率和晚期发病率，以及再次手术和导管介入的需要，最后，探讨晚期并发症的危险因素及再干预。
方法：对2006年1月至2022年1月在本中心接受ASO治疗的185例大动脉转位(TGA)患者的临床资料进行回顾性研究。
结果:有13例早期死亡(7.03%),5例晚期死亡（3.01%），和6失去了后续。166名住院幸存者的中位随访时间为88.5(2190)个月。中度或以上新发主动脉瓣反流(NAR；在本文中，NAR代表中度或更大的反流，除非另有说明）发生在19例（11.45%），28例(16.87%)发生主动脉根部扩张(ARD)。晚期右室流出道梗阻(RVOTO)33例(19.88%)。有18例患者（10.84％）接受了晚期再干预，最常见的干预指征是RVOTO，在同时进行弓修复和NAR或ARD的患者中，再发生主动脉缩窄。接收机工作特性分析发现，NAR对ARD的预测能力最强，其次是RVOTO,其次是二尖瓣天然肺动脉瓣（BPV），主肺直径不匹配（APDMM）最弱。多变量分析表明，APDMM，先前的肺动脉带（PAB），出院时轻度NAR是晚期NAR和ARD的独立危险因素。低手术体重是NAR特有的独立危险因素，BPV是ARD特有的独立危险因素。手术年龄和ARD是晚期RVOTO的独立危险因素。手术年龄较大，2014年之前运营，RVOTO后期，晚期ARD是晚期干预的独立危险因素。晚期未发现冠状动脉功能障碍的再干预事件。但1例患者在再次手术后因冠状动脉栓塞而发生心肌梗死。
结论：近几十年来，TGA患者ASO后的早期和晚期生存率得到了显著改善。增加NAR的比率，ARD,复发性主动脉缩窄,随着儿童年龄的增长和RVOTO是未来关注的主要结果，可能意味着更多的延迟再干预。必须仔细随访新主动脉瓣和根部功能，尤其是APDMM患者，上一个PAB,出院时轻度NAR,低手术重量，和BPV结构。
方法：对2006年1月至2022年1月在本中心接受ASO治疗的185例大动脉转位(TGA)患者的临床资料进行回顾性研究。
结果:有13例早期死亡(7.03%),5例晚期死亡（3.01%），和6失去了后续。166名住院幸存者的中位随访时间为88.5(2190)个月。中度或以上新发主动脉瓣反流(NAR；在本文中，NAR代表中度或更大的反流，除非另有说明）发生在19例（11.45%），28例(16.87%)发生主动脉根部扩张(ARD)。晚期右室流出道梗阻(RVOTO)33例(19.88%)。有18例患者（10.84％）接受了晚期再干预，最常见的干预指征是RVOTO，在同时进行弓修复和NAR或ARD的患者中，再发生主动脉缩窄。接收机工作特性分析发现，NAR对ARD的预测能力最强，其次是RVOTO,其次是二尖瓣天然肺动脉瓣（BPV），主肺直径不匹配（APDMM）最弱。多变量分析表明，APDMM，先前的肺动脉带（PAB），出院时轻度NAR是晚期NAR和ARD的独立危险因素。低手术体重是NAR特有的独立危险因素，BPV是ARD特有的独立危险因素。手术年龄和ARD是晚期RVOTO的独立危险因素。手术年龄较大，2014年之前运营，RVOTO后期，晚期ARD是晚期干预的独立危险因素。晚期未发现冠状动脉功能障碍的再干预事件。但1例患者在再次手术后因冠状动脉栓塞而发生心肌梗死。
结论：近几十年来，TGA患者ASO后的早期和晚期生存率得到了显著改善。增加NAR的比率，ARD,复发性主动脉缩窄,随着儿童年龄的增长和RVOTO是未来关注的主要结果，可能意味着更多的延迟再干预。必须仔细随访新主动脉瓣和根部功能，尤其是APDMM患者，上一个PAB,出院时轻度NAR,低手术重量，和BPV结构。
