Abstract：
OBJECTIVE: The aims of this study were to evaluate the 16-year experience with arterial switch operation at Beijing Children\'s Hospital and to determine early and late mortality and late morbidity, to explore risk factors for late complications and reintervention, and finally to evaluate whether the neoaortic sinotubular junction reconstruction technique reduces late complications of arterial switch operation.
METHODS: The clinical data of 185 patients with transposition of the great arteries who underwent arterial switch operation in Beijing Children\'s Hospital from January 2006 to January 2022 and 30 patients who underwent modified arterial switch operation with neoaortic sinotubular junction reconstruction technique in Fuwai Hospital during the same period were retrospectively analysed. Propensity score matching was also used to match the neoaortic sinotubular junction reconstruction patients in Fuwai Hospital with 30 non-neoaortic sinotubular junction reconstruction patients in Beijing Children\'s Hospital.
RESULTS: There were 13 early deaths (7.03%) and five late deaths (3.01%). Nineteen patients (11.45%) developed new aortic valve regurgitation and 28 patients (16.87%) developed aortic root dilation. Late right ventricular outflow tract obstruction occurred in 33 patients (19.88%). Late reintervention occurred in 18 cases (10.84%). Multivariate analysis showed that aorto-pulmonary diameter mismatch, previous pulmonary artery banding, and mild moderate or above new aortic valve regurgitation at discharge were independent risk factors for late new aortic valve regurgitation and aortic root dilation. Low surgical weight was an independent risk factor specific to new aortic valve regurgitation, and bicuspid native pulmonary valve was an independent risk factor specific to aortic root dilation. Older surgical age and aortic root dilation were independent risk factors for late right ventricular outflow tract obstruction. Older surgical age, operation before 2014, late right ventricular outflow tract obstruction, and late aortic root dilation were independent risk factors for late intervention. Propensity score matching showed that new aortic valve regurgitation and aortic root dilation were not followed up in the neoaortic sinotubular junction reconstruction group, while seven cases of aortic root dilation and five cases of new aortic valve regurgitation occurred in the non-neoaortic sinotubular junction reconstruction group, respectively, and the differences were statistically significant (P = 0.003; P = 0.015).
CONCLUSIONS: The increased incidence of new aortic valve regurgitation, aortic root dilation, and right ventricular outflow tract obstruction as children age is a major concern outcome in the future and may mean more late reintervention. neoaortic sinotubular junction reconstruction technique may reduce the incidence of new aortic valve regurgitation and aortic root dilation, and improve the late prognosis of arterial switch operation. Careful follow-up of neo-aortic valve and root function is imperative, especially in patients with aorto-pulmonary diameter mismatch, previous pulmonary artery banding, mild new aortic valve regurgitation at discharge, low surgical weight, and bicuspid native pulmonary valve structures.
METHODS: The clinical data of 185 patients with transposition of the great arteries who underwent arterial switch operation in Beijing Children\'s Hospital from January 2006 to January 2022 and 30 patients who underwent modified arterial switch operation with neoaortic sinotubular junction reconstruction technique in Fuwai Hospital during the same period were retrospectively analysed. Propensity score matching was also used to match the neoaortic sinotubular junction reconstruction patients in Fuwai Hospital with 30 non-neoaortic sinotubular junction reconstruction patients in Beijing Children\'s Hospital.
RESULTS: There were 13 early deaths (7.03%) and five late deaths (3.01%). Nineteen patients (11.45%) developed new aortic valve regurgitation and 28 patients (16.87%) developed aortic root dilation. Late right ventricular outflow tract obstruction occurred in 33 patients (19.88%). Late reintervention occurred in 18 cases (10.84%). Multivariate analysis showed that aorto-pulmonary diameter mismatch, previous pulmonary artery banding, and mild moderate or above new aortic valve regurgitation at discharge were independent risk factors for late new aortic valve regurgitation and aortic root dilation. Low surgical weight was an independent risk factor specific to new aortic valve regurgitation, and bicuspid native pulmonary valve was an independent risk factor specific to aortic root dilation. Older surgical age and aortic root dilation were independent risk factors for late right ventricular outflow tract obstruction. Older surgical age, operation before 2014, late right ventricular outflow tract obstruction, and late aortic root dilation were independent risk factors for late intervention. Propensity score matching showed that new aortic valve regurgitation and aortic root dilation were not followed up in the neoaortic sinotubular junction reconstruction group, while seven cases of aortic root dilation and five cases of new aortic valve regurgitation occurred in the non-neoaortic sinotubular junction reconstruction group, respectively, and the differences were statistically significant (P = 0.003; P = 0.015).
CONCLUSIONS: The increased incidence of new aortic valve regurgitation, aortic root dilation, and right ventricular outflow tract obstruction as children age is a major concern outcome in the future and may mean more late reintervention. neoaortic sinotubular junction reconstruction technique may reduce the incidence of new aortic valve regurgitation and aortic root dilation, and improve the late prognosis of arterial switch operation. Careful follow-up of neo-aortic valve and root function is imperative, especially in patients with aorto-pulmonary diameter mismatch, previous pulmonary artery banding, mild new aortic valve regurgitation at discharge, low surgical weight, and bicuspid native pulmonary valve structures.
摘要：
目的：这项研究的目的是评估在北京儿童医院进行动脉转换手术的16年经验，并确定早期和晚期死亡率和晚期发病率。探讨晚期并发症和再干预的危险因素，最后评估新主动脉窦管交界处重建技术是否减少了动脉转换手术的晚期并发症。
方法：回顾性分析2006年1月至2022年1月在北京儿童医院行大动脉转位手术的185例患者和同期在阜外医院行改良大动脉转位手术的30例患者的临床资料。采用倾向评分匹配法对阜外医院新主动脉窦管结重建患者与北京儿童医院30例非新主动脉窦管结重建患者进行匹配。
结果：有13例早期死亡（7.03%）和5例晚期死亡（3.01%）。19例患者（11.45％）发生新的主动脉瓣反流，28例患者（16.87％）发生主动脉根部扩张。右室流出道晚期梗阻33例(19.88%)。晚期再干预18例(10.84%)。多因素分析显示主肺内径不匹配,以前的肺动脉带，和轻度中度或以上出院时新发主动脉瓣反流是晚期新发主动脉瓣反流和主动脉根部扩张的独立危险因素。低手术体重是新发主动脉瓣反流的独立危险因素。和二尖瓣天然肺动脉瓣是主动脉根部扩张的独立危险因素。手术年龄大、主动脉根部扩张是晚期右室流出道梗阻的独立危险因素。手术年龄较大，2014年前手术，晚期右室流出道梗阻，晚期主动脉根部扩张是晚期干预的独立危险因素。倾向评分匹配显示新主动脉窦管交界处重建组未随访新主动脉瓣反流和主动脉根部扩张,非新主动脉窦管交界处重建组出现7例主动脉根部扩张和5例新生主动脉瓣反流,分别,差异均有统计学意义(P=0.003;P=0.015)。
结论：新发主动脉瓣反流的发生率增加，主动脉根部扩张,随着儿童年龄的增长,右心室流出道梗阻是未来主要关注的结果,可能意味着更多的延迟再干预.新主动脉窦管交界处重建技术可降低新发主动脉瓣反流和主动脉根部扩张的发生率,改善动脉转换手术的晚期预后。必须仔细随访新主动脉瓣和根部功能，尤其是主肺直径不匹配的患者，以前的肺动脉带，出院时轻度新发主动脉瓣反流,低手术重量，和二尖瓣天然肺动脉瓣结构。
方法：回顾性分析2006年1月至2022年1月在北京儿童医院行大动脉转位手术的185例患者和同期在阜外医院行改良大动脉转位手术的30例患者的临床资料。采用倾向评分匹配法对阜外医院新主动脉窦管结重建患者与北京儿童医院30例非新主动脉窦管结重建患者进行匹配。
结果：有13例早期死亡（7.03%）和5例晚期死亡（3.01%）。19例患者（11.45％）发生新的主动脉瓣反流，28例患者（16.87％）发生主动脉根部扩张。右室流出道晚期梗阻33例(19.88%)。晚期再干预18例(10.84%)。多因素分析显示主肺内径不匹配,以前的肺动脉带，和轻度中度或以上出院时新发主动脉瓣反流是晚期新发主动脉瓣反流和主动脉根部扩张的独立危险因素。低手术体重是新发主动脉瓣反流的独立危险因素。和二尖瓣天然肺动脉瓣是主动脉根部扩张的独立危险因素。手术年龄大、主动脉根部扩张是晚期右室流出道梗阻的独立危险因素。手术年龄较大，2014年前手术，晚期右室流出道梗阻，晚期主动脉根部扩张是晚期干预的独立危险因素。倾向评分匹配显示新主动脉窦管交界处重建组未随访新主动脉瓣反流和主动脉根部扩张,非新主动脉窦管交界处重建组出现7例主动脉根部扩张和5例新生主动脉瓣反流,分别,差异均有统计学意义(P=0.003;P=0.015)。
结论：新发主动脉瓣反流的发生率增加，主动脉根部扩张,随着儿童年龄的增长,右心室流出道梗阻是未来主要关注的结果,可能意味着更多的延迟再干预.新主动脉窦管交界处重建技术可降低新发主动脉瓣反流和主动脉根部扩张的发生率,改善动脉转换手术的晚期预后。必须仔细随访新主动脉瓣和根部功能，尤其是主肺直径不匹配的患者，以前的肺动脉带，出院时轻度新发主动脉瓣反流,低手术重量，和二尖瓣天然肺动脉瓣结构。
