Circulation:TGA患者大动脉转换术后心血管预后良好
2013-02-18 Circulation dxy xzdjh
目前完全型大动脉转位患者接受大动脉调转术后的长期预后的数据较少,马萨诸塞州波士顿儿童医院的Paul等研究人员对此进行了一项单中心回顾性队列研究,其结果发表在2013年1月23日的《循环》杂志上。 该研究用于评价1993-1999年间的大动脉调转术患者的心血管事件。联系3年之内未随访的患者,并获取次要来源的信息。总共400例患者,其中154 (38.3%)例有室间隔缺损,238 例(59.5%)
目前完全型大动脉转位患者接受大动脉调转术后的长期预后的数据较少,马萨诸塞州波士顿儿童医院的Paul等研究人员对此进行了一项单中心回顾性队列研究,其结果发表在2013年1月23日的《循环》杂志上。
该研究用于评价1993-1999年间的大动脉调转术患者的心血管事件。联系3年之内未随访的患者,并获取次要来源的信息。总共400例患者,其中154 (38.3%)例有室间隔缺损,238 例(59.5%) 患者的室间隔完整,9(2.3%)合并有 Taussig—Bing畸形,平均随访18.7年。围手术期的幸存者,25年的总体和无心律失常生存率分别为96.7±1.8% 和 96.6±0.1%。远期死亡率主要由猝死和心肌梗死造成。25年中,75.5±2.5%的患者未接受手术或导管再次介入治疗。无心血管不良事件发生的占92.9±1.9%。独立的预测因素为单右冠脉(危害比,4.58;95%可信区间,1.32-15.90)和术后心力衰竭(6.93;95% 可信区间,1.57-30.62; P=0.0107)。最近的一次随访中,左室射血分数为60.3±8.9%,97.3%的患者有I类症状,5.2% 患者有阻塞性冠状动脉疾病。峰值摄氧量为35.1±7.6 mL/kg/min ( 86.1±15.1%预测值),其中,34.2%的患者心脏变时指数<80%。出现术后主动脉瓣和肺动脉瓣轻度反流的患者分别3.4%和6.6%,术后主动脉瓣和肺动脉瓣狭窄中度以上者分别为3.2%和10.3%。
大动脉调转术后患者的长期预后良好,无心律失常生存率高。尽管有心脏变时功能不全、术后主动脉瓣、肺动脉瓣和冠状动脉疾病等后遗症,大多数患者保持正常的收缩功能和运动耐量。
Background—Data regarding long-term outcomes after the arterial switch operation for D-transposition of the great arteries are scarce.
Methods and Results—A single-institution retrospective cohort study was conducted to assess cardiovascular outcomes after an arterial switch operation between 1983 and 1999. Patients without follow-up visits within 3 years were contacted and secondary sources of information obtained. Overall, 400 patients, 154 (38.3%) with a ventricular septal defect, 238 (59.5%) with an intact septum, and 9 (2.3%) with a Taussig-Bing anomaly, were followed for a median of 18.7 years. In perioperative survivors, overall and arrhythmia-free survival rates at 25 years were 96.7±1.8% and 96.6±0.1%, respectively. Late mortality was predominantly a result of sudden deaths and myocardial infarction. At 25 years, 75.5±2.5% remained free from surgical or catheter-based reintervention. Freedom from an adverse cardiovascular event was 92.9±1.9% at 25 years. Independent predictors were a single right coronary artery (hazard ratio, 4.58; 95% confidence interval, 1.32-15.90), P=0.0166) and postoperative heart failure (hazard ratio, 6.93; 95% confidence interval, 1.57-30.62; P=0.0107). At last follow-up, the left ventricular ejection fraction was 60.3±8.9%, 97.3% had class I symptoms, and 5.2% obstructive coronary artery disease. Peak oxygen uptake was 35.1±7.6 mL/kg/min (86.1±15.1% predicted), with a chronotropic index <80% in 34.2%. At least moderate neoaortic and pulmonary regurgitation were present in 3.4% and 6.6%, respectively, and more than mild neoaortic and pulmonary stenosis in 3.2% and 10.3%.
Conclusions—Long-term and arrhythmia-free survival is excellent after arterial switch operation. Although sequelae include chronotropic incompetence and neoaortic, pulmonary, and coronary artery complications, most patients maintain normal systolic function and exercise capacity.
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#心血管预后#
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