10:30 〜 12:00
[II-S11-05] Arch anomalyを伴った大血管転位症/両大血管右室起始症の二心室修復術の外科治療成績
Arch anomalyを伴った大血管転位症/両大血管右室起始症の二心室修復術の外科治療成績
Outcomes of biventricular repair for transposition of the great arteries / double-outlet right ventricle with aortic arch obstruction
小田晋一郎、中野俊秀、檜山和弘、藤田智、渡邊マヤ、五十嵐仁、財満康之、坂口修平、角秀秋
Shinichiro Oda, Toshihide Nakano, Kazuhiro Hinokiyama, Satoshi Fujita, Maya Watanabe, Jin Ikarashi, Yasuyuki Zaima, Syuhei Sakaguchi, Hideaki Kado
福岡市立こども病院 心臓血管外科
The department of cardiovascular surgery, Fukuoka children’s hospital, Fukuoka, Japan.
[Objective] To compare the surgical outcomes of one-stage repair (group O) and two-stage repair (group T) of the biventricular repair for transposition of the great arteries (TGA) / double-outlet right ventricle (DORV) with aortic arch obstruction.
[Methods] Sixty-nine patients (group O, n=35, group T, n=34) were operated between 1987 and 2015. Prior procedures in group T were arch reconstruction with pulmonary artery band (PAB) (n=31) and bilateral PAB (n=3). The procedure of biventricular repair were arch reconstruction with arterial switch operation (ASO) (n=32), Kawashima procedure (n=2) and Yasui procedure (n=1) in group O and ASO (n=24), Kawashima (n=5) and Yasui (n=5) in group T. Follow-up periods were 11.6±7.7 years in group O and 14.4±9.2 years in group T.
[Results] There were 7 (20%) and 3 (8.8%) death in group O and T, respectively. Actuarial survivals were 80% at 5 and 10 years in group O, and 93.9% and 89.9% at 5 and 10 years, respectively in group T (p=0.20). Deaths caused by postoperative low cardiac output syndrome (LOS) and/or active pulmonary bleeding occurred in 5 all in group O. There were 11 (31.4%) and 16 (47.1%) re-interventions in group O and T, respectively. Freedom from re-intervention at 5 and 10 years was 71.4% and 67.9% in group O and 62.1% and 49% in group T, respectively (p=0.27).
[Conclusions] Both one-stage and two-stage repair can be performed with acceptable mortality and morbidity. However, the two-stage repair had an advantage of avoiding postoperative LOS and pulmonary bleeding, which may be accompanied by an invasive surgery.
Outcomes of biventricular repair for transposition of the great arteries / double-outlet right ventricle with aortic arch obstruction
小田晋一郎、中野俊秀、檜山和弘、藤田智、渡邊マヤ、五十嵐仁、財満康之、坂口修平、角秀秋
Shinichiro Oda, Toshihide Nakano, Kazuhiro Hinokiyama, Satoshi Fujita, Maya Watanabe, Jin Ikarashi, Yasuyuki Zaima, Syuhei Sakaguchi, Hideaki Kado
福岡市立こども病院 心臓血管外科
The department of cardiovascular surgery, Fukuoka children’s hospital, Fukuoka, Japan.
[Objective] To compare the surgical outcomes of one-stage repair (group O) and two-stage repair (group T) of the biventricular repair for transposition of the great arteries (TGA) / double-outlet right ventricle (DORV) with aortic arch obstruction.
[Methods] Sixty-nine patients (group O, n=35, group T, n=34) were operated between 1987 and 2015. Prior procedures in group T were arch reconstruction with pulmonary artery band (PAB) (n=31) and bilateral PAB (n=3). The procedure of biventricular repair were arch reconstruction with arterial switch operation (ASO) (n=32), Kawashima procedure (n=2) and Yasui procedure (n=1) in group O and ASO (n=24), Kawashima (n=5) and Yasui (n=5) in group T. Follow-up periods were 11.6±7.7 years in group O and 14.4±9.2 years in group T.
[Results] There were 7 (20%) and 3 (8.8%) death in group O and T, respectively. Actuarial survivals were 80% at 5 and 10 years in group O, and 93.9% and 89.9% at 5 and 10 years, respectively in group T (p=0.20). Deaths caused by postoperative low cardiac output syndrome (LOS) and/or active pulmonary bleeding occurred in 5 all in group O. There were 11 (31.4%) and 16 (47.1%) re-interventions in group O and T, respectively. Freedom from re-intervention at 5 and 10 years was 71.4% and 67.9% in group O and 62.1% and 49% in group T, respectively (p=0.27).
[Conclusions] Both one-stage and two-stage repair can be performed with acceptable mortality and morbidity. However, the two-stage repair had an advantage of avoiding postoperative LOS and pulmonary bleeding, which may be accompanied by an invasive surgery.