Objective To evaluate the impact of an integrated management mode of prenatal diagnosis-postnatal treatment for congenital heart disease (CHD) on perioperative and long-term outcomes of the arterial switch operation (ASO), and to analyze the efficacy of ASO in a single center. Methods This retrospective study analyzed the clinical data of 183 children who underwent ASO at Guangdong Provincial People’s Hospital from 2018 to 2024. The cohort included 106 (57.9%) patients of transposition of the great arteries with intact ventricular septum (TGA/IVS), 61 (33.3%) patients of transposition of the great arteries with ventricular septal defect (TGA/VSD), and 16 (8.7%) patients of Taussig-bing anomaly (TBA). Perioperative indicators were compared between 91 patients in the prenatal-postnatal integrated management group (an integrated group) and 92 patients in the traditional management group (a non-integrated group). Long-term survival and reoperation rates were analyzed using Kaplan-Meier curves. Results The overall perioperative mortality rate was 4.9% (9/183), showing a downward trend year by year. The primary cause of perioperative mortality was low cardiac output syndrome (LCOS), which occurred in 12 patients (6.6% incidence) with a mortality rate of 75.0%. The integrated group had a higher proportion of males (89.0% vs. 72.8%, P<0.05) and lower body weight [3.1 (2.7, 3.3) kg vs. 3.3 (3.0, 3.7) kg, P<0.05] compared to the non-integrated group. The age at surgery was significantly earlier in the integrated group [7 (3, 10) d vs. 14 (9, 48) d, P<0.05], and all children in the integrated group underwent ASO within the optimal surgical window (100.0% vs. 82.6%, P<0.05). Intraoperatively, cardiopulmonary bypass time [173 (150, 207) min vs. 186 (159, 237) min, P<0.05] and aortic cross-clamp time [100 (90, 117) min vs. 116 (97, 142) min, P<0.05] were significantly shorter in the integrated group. Although the integrated group had longer postoperative mechanical ventilation time [145 (98, 214) h vs. 116 (77, 147) h, P<0.05] and higher 48-hour maximum vasoactive inotropic score [15 (10, 21) points vs. 12 (8, 16) points, P<0.05], there was no statistically significant difference in the incidence of severe complications (LCOS, necrotizing enterocolitis, extracorporeal membrane oxygenation) or mortality rate (3.3% vs. 6.5%, P=0.51) between the two groups, despite earlier surgical intervention and a higher proportion of critically ill cases in the integrated group. The length of hospital stay in the emergency surgery group was significantly shorter than that in the elective surgery group [20 (15, 28) d vs. 25 (21, 30) d, P<0.05], suggesting that early surgery may be of potential benefit. A total of 163 patients were successfully followed up for a median of 4.7 years, with a 5-year survival rate of 95.1% and a freedom from reintervention survival rate of 95.1%. There were no late deaths, and the most common postoperative complication was pulmonary artery stenosis. Conclusion The integrated management model allowed critically ill children with lower body weights to safely undergo surgery, significantly optimizing the timing of surgery and shortening intraoperative times. The long-term risk of reoperation after ASO is primarily concentrated on pulmonary artery stenosis, necessitating long-term follow-up and monitoring.
ObjectiveTo summarize the early and mid-term surgical outcomes of cone reconstruction for Ebstein’s anomaly. MethodsPatients with Ebstein’s anomaly who underwent cone reconstruction at Guangdong Provincial People’s Hospital from 2015 to 2024 were retrospectively enrolled. Baseline characteristics, echocardiographic parameters before and after surgery, and follow-up results were collected and analyzed. ResultsA total of 115 patients were included, comprising 28 males and 87 females, with a mean age of (33.29±15.72) years. There were 94 patients in the adult group (>14 years old), and 21 patients in the pediatric group (≤14 years old). Severe or greater tricuspid regurgitation was present in 98.3% of patients preoperatively, and 89.6% were in New York Heart Association (NYHA) functional class Ⅱ. All patients successfully underwent cone reconstruction. The in-hospital reoperation rate for tricuspid valve disease was 1.7%, and no in-hospital death occurred. In the pediatric group, tricuspid regurgitation area and right atrial longitudinal dimension were significantly smaller at 5 days, 6 months, and 1 year postoperatively than preoperative values (P<0.05). In the adult group (n=92, excluding 2 patients who underwent in-hospital reoperation for tricuspid valve disease), tricuspid regurgitation area, pulmonary artery systolic pressure, right atrial longitudinal dimension and anteroposterior diameter of the right ventricular outflow tract were significantly decreased at 5 days, 6 months, and 1 year after surgery (P<0.05), while the right ventricular longitudinal dimension was significantly increased (P<0.001) compared to preoperative levels. The left ventricular end-diastolic and end-systolic diameters were significantly increased at 6 months and 1 year postoperatively (P<0.001). Right heart functional parameters (right ventricular fractional area change, tricuspid annular plane systolic excursion, and tricuspid annular myocardial systolic velocity) demonstrated a trend of gradual recovery after an initial decline in the early postoperative period. The median follow-up duration was 1.8 years, with a follow-up rate of 95.7%. During the follow-up, 3 patients underwent repeated tricuspid valve surgery and 1 patient died. ConclusionCone reconstruction is safe and effective for Ebstein’s anomaly, and can significantly alleviate tricuspid regurgitation and reverse right heart structural remodeling. Both pediatric and adult patients achieve marked improvements in tricuspid regurgitation and right heart morphology, additionally, adult patients also gain obvious benefits in left heart function. Postoperative right heart function shows a gradual recovery trend, with favorable mid-term follow-up outcomes.