Congenitally corrected transposition of the great arteries:anatomic repair or fontan pathway?
10.3760/cma.j.issn.1001-4497.2019.01.004
- VernacularTitle:先天性矫正型大动脉转位的外科治疗:解剖矫治还是Fontan手术
- Author:
Minghui ZOU
1
;
Li MA
;
Shengchun YANG
;
Fan CAO
;
Yuansheng XIA
;
Weidan CHEN
;
Wenlei LI
;
Xinxin CHEN
Author Information
1. 广州医科大学附属广州市妇女儿童医疗中心心脏中心 510623
- Keywords:
Congenitally corrected transposition of the great arteries;
Anatomic repair;
Double switch;
Fontan
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2019;35(1):14-18
- CountryChina
- Language:Chinese
-
Abstract:
Objective To review the early-and mid-term results of anatomic repair or Fontan pathway for congenitally corrected transposition of the great arteries(ccTGA) in a single institution of China.Methods Hospital records over a 9-year period(2009-2017) were reviewed to identify patients with ccTGA who underwent anatomic repair or Fontan pathway.Pa-tient-and procedure-related variables were reviewed.Results We identified 37 patients.Group 1 consisted of 10 anatomic re-pairs, of which 4 required prior pulmonary artery banding.Median age at anatomic repair was 1.0 years( range: 0.3 -7.8 years).There was one early death, and one patients experienced ECMO support.The mean follow-up was(3.0 ±2.8)years (range:0.7-8.4 years).Five(55.5％) patients showed arrhythmias, and one required permanent pacemaker implantation during follow-up.Group 2(27 patients) underwent Fontan palliation, of which 23(85.2％) underwent prior bidirectional Glenn shunt.Median age at Fontan completion was 3.8years(range:2.2-14.3 years).there was one early death with a mor-tality of 3.7％.The mean follow-up was(2.8 ±1.6) years(range:0.8-8.2 years).There was 4(15.4％) cases of arrhyth-mias, but none required reintervention.The arrhythmias incidence in Fontan group was significantly lower than the anatomic re-pair group.The early-and mid-term survival rate were 90.0％ and 96.3％in the two groups.The difference was not statistical-ly significant(P=0.458).Conclusion Patients with ccTGA do well with both anatomic repair and the Fontan pathway in the medium term.Pulmonary artery banding can be used effectively for morphological left ventricular retraining , and extenuate tri-cuspid regurgitation.Excellent outcomes with reduced early complication and arrhythmias incidence can be achieved for this co-hort of patients when a strategy of avoiding complex anatomic repair in favor of the Fontan pathway is used .
