背景:心房转换修复术(AtrSR)是构成右心室的大动脉D转位(D-TGA)患者的最初手术方法。目前,它已被动脉开关操作(ASO)取代,但AtrSR后的成人队列仍然很大,需要对晚期并发症进行严格的心脏病学管理.出于这个原因,我们旨在评估AtrSR(芥末或Senning手术)后D-TGA患者的潜在长期死亡危险因素。方法:我们在MEDLINE数据库中搜索合适的试验.我们纳入了22项D-TGA患者的回顾性和前瞻性队列研究,在芥末或Senning手术后至少5年平均/中位随访时间,手术后至少30天后,终点为非心脏性猝死(n-SCD)和心脏性猝死(SCD)。
结果:共纳入2912例患者,其中351人符合n-SCD/SCD的联合终点。长期死亡危险因素为纽约心脏协会(NYHA)≥III级/心力衰竭住院(比值比[OR],7.25;95%置信区间[CI],2.67-19.7),三尖瓣返流(OR,4.64;95%CI,1.95-11.05),芥末程序(或,2.15;95%CI,1.37-3.35),复数D-TGA(或,2.41;95%CI,1.31-4.43),和右心室功能障碍(OR,1.94;95%CI,0.99-3.79)。室上性心律失常(室上性心律失常;或,2.07;95%CI,0.88-4.85)和起搏器植入(OR,2.37;95%CI,0.48-11.69)不影响该组患者的长期生存率。在额外的分析中,SVT对SCD有统计学意义的影响(OR,2.74;95%CI,1.36-5.53),但不在n-SCD(OR,1.5;95%CI,0.37-6.0)。
结论:这项荟萃分析表明,至少中度三尖瓣返流,NYHA等级≥III级/心力衰竭住院,右心室功能障碍,复杂的D-TGA,和芥末手术是AtrSR术后患者长期死亡的危险因素。
Atrial switch repair (AtrSR) was the initial operation method in patients with D-transposition of the great arteries (D-TGA) constituting the right ventricle as a systemic one. Currently, it has been replaced with arterial switch operation (ASO), but the cohort of adults after AtrSR is still large and requires strict cardiological management of late complications. For this reason, we aimed to evaluate potential long-term mortality risk factors in patients with D-TGA after AtrSR (either Mustard or Senning procedures) Methods: We searched the MEDLINE database for suitable trials. We included 22 retrospective and prospective cohort studies of patients with D-TGA with at least 5 years mean/median follow-up time after Mustard or Senning procedures, with an endpoint of non-sudden cardiac death (n-SCD) and sudden cardiac death (SCD) after at least 30 days following surgery.
A total of 2912 patients were enrolled, of whom 351 met the combined endpoint of n-SCD/SCD. The long-term mortality risk factors were New York Heart Association (NYHA) class ≥III/heart failure hospitalization (odds ratio [OR], 7.25; 95% confidence interval [CI], 2.67-19.7), tricuspid valve regurgitation (OR, 4.64; 95% CI, 1.95-11.05), Mustard procedure (OR, 2.15; 95% CI, 1.37-3.35), complex D-TGA (OR, 2.41; 95% CI, 1.31-4.43), and right ventricular dysfunction (OR, 1.94; 95% CI, 0.99-3.79). Supraventricular arrhythmia (SVT; OR, 2.07; 95% CI, 0.88-4.85) and pacemaker implantation (OR, 2.37; 95% CI, 0.48-11.69) did not affect long-term survival in this group of patients. In an additional analysis, SVT showed a statistically significant impact on SCD (OR, 2.74; 95% CI, 1.36-5.53) but not on n-SCD (OR, 1.5; 95% CI, 0.37-6.0).
This meta-analysis demonstrated that at least moderate tricuspid valve regurgitation, NYHA class ≥III/heart failure hospitalization, right ventricular dysfunction, complex D-TGA, and Mustard procedure are risk factors for long-term mortality in patients after AtrSR.