초록접수 현황
| 17F-104 | 구연 발표 |
Risk Factors of 30-day-mortality after Arterial Switch Operation; Neoaorta-reconstruction-first Technique can make Difference
Kwang Ho Choi¹, Si Chan Sung¹, Hyungtae Kim¹, Hyoung Doo Lee², Geena Kim², Hoon Ko²
¹Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Gyeongsangnam-do, Republic of Korea., ²Department of Pediatric cardiology, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Gyeongsangnam-do, Republic of Korea
Purpose : Coronary reimplantation after neoaortic reconstruction have several technical advantages. We reviewed the 30-day-mortality after arterial switch operation and conducted its risk factor evaluation to see if neoaorta-reconstruction-first technique can affect on 30-day-mortality of the arterial switch operation.
Methods : From March 1994 to July 2017, 227 patients underwent ASO. Preoperative diagnosis were TGA with intact ventricular septum(n=116), TGA with ventricular septal defect(n=60), TGA with VSD and arch anomaly(n=10), Taussig-Bing anomaly(n=14), and Taussig-Bing anomaly with arch anomaly(n=27).
Results : Overall postoperative early mortality was 7.5%(17/227). There was no difference in the mortality between the patients with usual and unusual coronary patterns[8.2%(12/147) vs, 6.2%(5/80), p=0.601]. The patients group with arch anomaly had higher early mortality[21.6% (8/37) vs. 4.7% (9/190), p<0.001]. The patients group who underwent an open coronary reimplantation technique had higher early mortality[19.4% (14/72)] as compared to those who underwent neoaorta-reconstruction-first technique[1.9% (3/155)]. In the patients with arch anomaly, the early mortality was 54.5%(6/11) in the patients who underwent open coronary reimplantation technique, but 7.7%(2/26) in those who underwent neoaorta-reconstruction-first technique(p=0.002). Risk factors for postoperative early mortality from multivariate analysis were cardiopulmonary bypass time [p<0.001, OR 1.021(1.009, 1.032)] and open coronary reimplantation technique [p<0.001, OR 17.286 (3.628, 82.360)].
Conclusion : The cardiopulmonary bypass time and open coronary artery reimplantation technique were important risk factors for postoperative early mortality of the arterial switch operation. Neoaorta-reconstruction-first technique can reduce the early postoperative mortality after arterial switch operation. This favorable result is more prominent in the patients with aortic arch anormaly
Methods : From March 1994 to July 2017, 227 patients underwent ASO. Preoperative diagnosis were TGA with intact ventricular septum(n=116), TGA with ventricular septal defect(n=60), TGA with VSD and arch anomaly(n=10), Taussig-Bing anomaly(n=14), and Taussig-Bing anomaly with arch anomaly(n=27).
Results : Overall postoperative early mortality was 7.5%(17/227). There was no difference in the mortality between the patients with usual and unusual coronary patterns[8.2%(12/147) vs, 6.2%(5/80), p=0.601]. The patients group with arch anomaly had higher early mortality[21.6% (8/37) vs. 4.7% (9/190), p<0.001]. The patients group who underwent an open coronary reimplantation technique had higher early mortality[19.4% (14/72)] as compared to those who underwent neoaorta-reconstruction-first technique[1.9% (3/155)]. In the patients with arch anomaly, the early mortality was 54.5%(6/11) in the patients who underwent open coronary reimplantation technique, but 7.7%(2/26) in those who underwent neoaorta-reconstruction-first technique(p=0.002). Risk factors for postoperative early mortality from multivariate analysis were cardiopulmonary bypass time [p<0.001, OR 1.021(1.009, 1.032)] and open coronary reimplantation technique [p<0.001, OR 17.286 (3.628, 82.360)].
Conclusion : The cardiopulmonary bypass time and open coronary artery reimplantation technique were important risk factors for postoperative early mortality of the arterial switch operation. Neoaorta-reconstruction-first technique can reduce the early postoperative mortality after arterial switch operation. This favorable result is more prominent in the patients with aortic arch anormaly
책임저자: Si Chan Sung
Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Gyeongsangnam-do, Republic of Korea
발표자: Kwang Ho Choi, E-mail : ppippo77@gmail.com