.: ORİJİNAL ARAŞTIRMA
Arteriyel Switch Operasyonlarında Açık Trap-Door Tekniği ve Kapalı Koroner Transfer Tekniği Sonuçlarının Karşılaştırılması: Retrospektif Klinik Araştırma
Comparison of the Results of Open Trap-Door Technique and Closed Coronary Transfer Technique in Arterial Switch Operations: A Retrospective Clinical Study
Turkiye Klinikleri J Cardiovasc Sci. 2022;34(3):97-105
doi: 10.5336/cardiosci.2022-93815
Makale Dili: TR
Tam Metin
ÖZET
Amaç: Arteriyel switch operasyonlarında, koroner translokasyon işleminin doğru yapılması ameliyatın başarısını etkileyen en önemli ögedir. Bu çalışmada, koroner arterlerin transferi için kullanılan 2 farklı translokasyon tekniğinin sonuçlarını karşılaştırdık. Gereç ve Yöntemler: Aralık 2017-Mayıs 2022 tarihleri arasında ardışık 108 hastaya arteriyel switch ameliyatı yapıldı. Hastaların tanıları intakt ventriküler septumlu büyük arter transpozisyonu (BAT) (n=68), ventriküler septal defektli BAT (n=34) ve Taussig-Bing anomalisi (n=6) idi. Yedi hastada aortik arkus anomalisi eşlik ediyordu. Hastaların 70'ine açık trap-door tekniği ile koroner trasfer yapıldı (Grup=1); 38 hastada kapalı koroner transfer metodu uygulandı (Grup=2). Bulgular: Hastaların 86'sı erkek, 22'si kız, medyan yaşı 13 gün ve ortalama vücut ağırlığı 3,3 kg'dı. Gruplar arasında ameliyat esnasındaki vücut ağırlığı, büyük arter ilişkisi ve koroner anomali varlığı bakımından fark yoktu. Tüm hastalar genelinde erken mortalite %12 (n=13) idi. Yirmi altı (%24,1) hastada koroner arter anomalisi saptandı. Koroner arter anomalisi olan hastalarda olmayanlara göre mortalite daha yüksekti (p=0,006). Grup 1 ve Grup 2 arasında komplikasyon ve mortalite bakımından anlamlı fark yoktu. Grup 2'deki hastalarda kros klemp süresi (p=0,009), kardiyopulmoner baypas süresi (p=0,001), yoğun bakımda kalış süresi (p=0,01), hastanede kalış süresi (p=0,001) ve vazoaktif inotrop skoru (p<0,001) Grup 1'deki hastalardan anlamlı olarak daha düşüktü. Takipte Grup 1'de hafif neoaortik kapak yetersizliği oranı Grup 2'den yüksekti (p=0,046). Sonuç: Kapalı teknik daha kısa kros klemp ve kardiyopulmoner baypas zamanı, daha kısa yoğun bakımda ve hastanede kalış süresi, daha düşük vazoaktif inotrop skoru sağlar ve bu teknik postoperatif neoaortik kapak yetersizliği riskini azaltır.
Anahtar Kelimeler: Arteriyel switch ameliyatı; koroner damarlar; reimplantasyon; büyük damarların transpozisyonu
Amaç: Arteriyel switch operasyonlarında, koroner translokasyon işleminin doğru yapılması ameliyatın başarısını etkileyen en önemli ögedir. Bu çalışmada, koroner arterlerin transferi için kullanılan 2 farklı translokasyon tekniğinin sonuçlarını karşılaştırdık. Gereç ve Yöntemler: Aralık 2017-Mayıs 2022 tarihleri arasında ardışık 108 hastaya arteriyel switch ameliyatı yapıldı. Hastaların tanıları intakt ventriküler septumlu büyük arter transpozisyonu (BAT) (n=68), ventriküler septal defektli BAT (n=34) ve Taussig-Bing anomalisi (n=6) idi. Yedi hastada aortik arkus anomalisi eşlik ediyordu. Hastaların 70'ine açık trap-door tekniği ile koroner trasfer yapıldı (Grup=1); 38 hastada kapalı koroner transfer metodu uygulandı (Grup=2). Bulgular: Hastaların 86'sı erkek, 22'si kız, medyan yaşı 13 gün ve ortalama vücut ağırlığı 3,3 kg'dı. Gruplar arasında ameliyat esnasındaki vücut ağırlığı, büyük arter ilişkisi ve koroner anomali varlığı bakımından fark yoktu. Tüm hastalar genelinde erken mortalite %12 (n=13) idi. Yirmi altı (%24,1) hastada koroner arter anomalisi saptandı. Koroner arter anomalisi olan hastalarda olmayanlara göre mortalite daha yüksekti (p=0,006). Grup 1 ve Grup 2 arasında komplikasyon ve mortalite bakımından anlamlı fark yoktu. Grup 2'deki hastalarda kros klemp süresi (p=0,009), kardiyopulmoner baypas süresi (p=0,001), yoğun bakımda kalış süresi (p=0,01), hastanede kalış süresi (p=0,001) ve vazoaktif inotrop skoru (p<0,001) Grup 1'deki hastalardan anlamlı olarak daha düşüktü. Takipte Grup 1'de hafif neoaortik kapak yetersizliği oranı Grup 2'den yüksekti (p=0,046). Sonuç: Kapalı teknik daha kısa kros klemp ve kardiyopulmoner baypas zamanı, daha kısa yoğun bakımda ve hastanede kalış süresi, daha düşük vazoaktif inotrop skoru sağlar ve bu teknik postoperatif neoaortik kapak yetersizliği riskini azaltır.
Anahtar Kelimeler: Arteriyel switch ameliyatı; koroner damarlar; reimplantasyon; büyük damarların transpozisyonu
ABSTRACT
Objective: Correct coronary translocation is the most important factor affecting the success of the operation in arterial switch operations. In this study, we compared the results of 2 different translocation techniques used for the transfer of coronary arteries. Material and Methods: Arterial switch surgery was performed on 108 consecutive patients between December 2017 and May 2022. The diagnoses of the patients were transposition of the great arteries with intact ventricular septum (n=68), transposition of the great arteries with ventricular septal defect (n=34) and Taussig-Bing anomaly (n=6). Aortic arch anomaly was accompanied in 7 patients. Coronary transfer was performed with the open trap-door technique in 70 of the patients (Group=1); closed coronary transfer method was applied in 38 patients (Group=2). Results: Eighty-six of the patients were male, 22 were female, median age was 13 days and mean body weight was 3.3 kg. There was no difference between the groups in terms of operative body weight, great artery relationship and presence of coronary anomaly. Early mortality was 12% (n=13) in all patients. Coronary artery anomaly was detected in 26 (24.1%) patients. Mortality was higher in patients with coronary artery anomaly than those without (p=0.006). There was no significant difference between Group 1 and Group 2 in terms of complications and mortality. In Group 2, cross-clamp time (p=0.009), cardiopulmonary bypass time (p=0.001), length of stay in the intensive care unit (p=0.01), length of hospital stay (p=0.001) and vasoactive inotrope score (p<0.001) was significantly lower than the patients in Group 1. At the follow-up, the rate of mild neo-aortic valve regurgitation in Group 1 was higher than in Group 2 (p=0.046). Conclusion: The closed technique provides shorter crossclamp and cardiopulmonary bypass time, shorter intensive care unit and hospital stay, lower vasoactive inotrope score, and this technique reduces the risk of postoperative neoaortic valve insufficiency.
Keywords: Arterial switch operation; coronary vessels; reimplantation; transposition of great vessels
Objective: Correct coronary translocation is the most important factor affecting the success of the operation in arterial switch operations. In this study, we compared the results of 2 different translocation techniques used for the transfer of coronary arteries. Material and Methods: Arterial switch surgery was performed on 108 consecutive patients between December 2017 and May 2022. The diagnoses of the patients were transposition of the great arteries with intact ventricular septum (n=68), transposition of the great arteries with ventricular septal defect (n=34) and Taussig-Bing anomaly (n=6). Aortic arch anomaly was accompanied in 7 patients. Coronary transfer was performed with the open trap-door technique in 70 of the patients (Group=1); closed coronary transfer method was applied in 38 patients (Group=2). Results: Eighty-six of the patients were male, 22 were female, median age was 13 days and mean body weight was 3.3 kg. There was no difference between the groups in terms of operative body weight, great artery relationship and presence of coronary anomaly. Early mortality was 12% (n=13) in all patients. Coronary artery anomaly was detected in 26 (24.1%) patients. Mortality was higher in patients with coronary artery anomaly than those without (p=0.006). There was no significant difference between Group 1 and Group 2 in terms of complications and mortality. In Group 2, cross-clamp time (p=0.009), cardiopulmonary bypass time (p=0.001), length of stay in the intensive care unit (p=0.01), length of hospital stay (p=0.001) and vasoactive inotrope score (p<0.001) was significantly lower than the patients in Group 1. At the follow-up, the rate of mild neo-aortic valve regurgitation in Group 1 was higher than in Group 2 (p=0.046). Conclusion: The closed technique provides shorter crossclamp and cardiopulmonary bypass time, shorter intensive care unit and hospital stay, lower vasoactive inotrope score, and this technique reduces the risk of postoperative neoaortic valve insufficiency.
Keywords: Arterial switch operation; coronary vessels; reimplantation; transposition of great vessels
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