Phẫu thuật chuyển vị động mạch cho trẻ >1 tháng tuổi mắc bệnh tim chuyển gốc-vách liên thất nguyên vẹn: chiến lược điều trị và kết quả trung hạn tại bệnh viện Nhi Trung ương
Authors: Nguyễn Trường 
Published: April 2023

TÓM TẮT

Mục tiêu: Nghiên cứu này nhằm đánh giá kết quả trung hạn phẫu thuật chuyển vị động mạch đối với trẻ mắc bệnh chuyển gốc động mạch - vách liên thất nguyên vẹn > 1 tháng tuổi cũng như ảnh hưởng của chiến lược điều trị đến kết quả phẫu thuật.

Đối tượng, phương pháp: Trong thời gian từ tháng 4 năm 2010 đến tháng 11 năm 2016, các bệnh nhân chẩn đoán chuyển gốc động mạch - vách liên thất nguyên vẹn có độ tuổi > 1 tháng tuổi được phẫu thuật chuyển vị động mạch tại Trung tâm Tim mạch - Bệnh viện Nhi Trung ương được hồi cứu.

Kết quả: Trong thời gian tiến hành nghiên cứu, có tổng số 48 bệnh nhân phù hợp tiêu chuẩn được lựa chọn vào nghiên cứu. Tuổi phẫu thuật trung bình là 53,83 ± 27,15 ngày tuổi (31 - 163), cân nặng trung bình là 3,71 ± 0,76kg. Chỉ có 2 bệnh nhân cần được huấn luyện thất trái trước phẫu thuật. Thời gian cặp động mạch chủ trung bình là 125,60 ± 25,73 phút, thời gian chạy máy 197,67 ± 66,66 phút. Có 2 bệnh nhân (4,2%) tử vong sớm và 1 bệnh nhân tử vong muộn (2,1%). Không có bệnh nhân nào cần phải mổ lại do nguyên nhân tim mạch trong thời gian theo dõi trung bình là 29,85 ± 19,50 tháng (5 - 84).

Kết luận: Kết quả trung hạn phẫu thuật chuyển vị động mạch điều trị cho các bệnh nhân chuyển gốc động mạch - vách liên thất nguyên vẹn > 1 tháng tuổi tại Trung tâm Tim mạch - Bệnh viện Nhi Trung ương là rất tốt. Phẫu thuật chuyển vị động mạch thì đầu có thể được cân nhắc mặc dù giới hạn trên của độ tuổi bệnh nhân vẫn chưa được xác định.

ABSTRACT

Surgical strategies and intermediate outcomes of arterial switch operation for patients have transposition of the great arteries - intact ventricular septum greater than 1 month old at Vietnam National Children’s Hospital

Objective: This study was conducted to evaluate the mid - term outcomes of arterial switch operation for children who have transposition of the great arteries - intact ventricular septum beyond 1 month of age and assess the influence of management strategy on surgical outcomes.

Methods: A retrospective study was conducted for the patients diagnosed with transposition of the great arteries - intact ventricular septum older than 1 month who underwent arterial switch operation from April 2010 to November 2016 at Heart Center- Vietnam National Children Hospital.

Results: During the study period, forty - eight patients older than 1 month old were collected for this study. The operation mean age and mean weight was 53.83 ± 27.15 days (31 - 163), and 3.71 ± 0.76kg, respectively. There were only 2 patients who required left ventricular training before arterial switch operation. The mean aortic cross - clamp time and mean bypass time was 125.60 ± 25.73min, and 197.67 ± 66.66min, respectively. 2 patients (4.2%) death in hospital and 1 late death (2.1%). No reoperation appears during the mean time follow - up of 29.85 ± 19.50 months (5 - 84).

Conclusions: Results of arterial switch operation for patients diagnosed with transposition of the great arteries - intact ventricular septum older than 1 month at Children Heart Center - Vietnam National Children Hospital are safe. Primary arterial switch operation is an option to be considered, but the upper age limit for transposition of the great arteries - intact ventricular septum is not yet defined.