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| 大动脉转位患者由心房调转改为动脉调转术出院后长期生存改善，但未能减少再次手术的需要 |
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| Improvement in long-term survival after hospital discharge but not in freedom from reoperation after the change from atrial to arterial switch for transposition of the great arteries |
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| Hörer J, Schreiber C, Cleuziou J 2009/7/24 12:13:21 |
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| J Thorac Cardiovasc Surg, 2009, |
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| View at Publisher |
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Objective:
To compare survival, freedom from reoperation, and functional status between atrial switch and arterial switch operations for transposition of the great arteries.
Methods:
Data from 88, 329, and 512 patients who underwent Mustard, Senning, and arterial switch operations between 1974 and 2006 were analyzed.
Results:
In-hospital mortalities were 8.0% for Mustard, 4.6% for Senning, and 6.4% for arterial switch. Presence of ventricular septal defect (hazard ratio 3.3, P<.001) was the only risk factor for in-hospital mortality in multivariate analysis. Follow-up for Mustard was 22.6±8.1 years, for Senning was 18.2±5.7 years, and for arterial switch was 9.5±5.7 years. Highest survival at 20 years was after arterial switch (96.6%±1.3%), followed by Senning (92.6%±1.5%) and Mustard (82.4%±4.3%). Transposition with ventricular septal defect (hazard ratio 3.1, P<.001), transposition with ventricular septal defect and left ventricular outflow tract obstruction (hazard ratio 3.0, P=.029), and Mustard operation (hazard ratio 2.1, P=.011) emerged as risk factors for late death, with arterial switch a protective factor (hazard ratio 0.3, P=.010). Highest freedom from reoperation at 20 years was after Senning (88.7%±1.9%), followed by arterial switch (75.0%±6.4%) and Mustard (70.6%±5.4%). Presence of complex transposition (hazard ratio 2.1, P<.001), previous palliative operation (hazard ratio 1.8, P=.016), surgery between 1985 and 1995 (hazard ratio 2.6, P=.002), surgery after 1995 (hazard ratio 3.5, P<.001), and Mustard operation (hazard ratio 3.3, P<.001) emerged as risk factors for reoperation.
Conclusion:
Change from atrial to arterial switch led to improved long-term survival after hospital discharge but not to lower incidence of reoperation. Survival and freedom from reoperation are determined by morphology.
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 疾病资源中心
病例分析 [栏目介绍]
王燕燕 王曙
上海交通大学附属瑞金医院内分泌科
患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。
医学数据库
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