ObjectiveTo explore the early results of Ozaki operation in children with aortic regurgitation.MethodsWe retrospectively analyzed the clinical data of 15 patients with aortic regurgitation who received the Ozaki operation in our hospital from April 2017 to July 2019. There were 11 males and 4 females with an average operation age of 10.7±3.7 years. Besides preoperative evaluation, aortic regurgitation and cardiac function were evaluated on 1 day, 1 week, 1 month, 3 months, and 6-12 months after surgery.ResultsIn 14 (93.3%) patients , the aortic valve leaflets functioned well on 1 day, 1 month, 3 months, and 6-12 months, and the regurgitation grade was Ⅰ-Ⅱ, which was improved than before (P=0.001). The cardiac function of children recovered quickly after operation. There was no statistical difference in ejection fraction on 1 day, 1 month, 3 months, and 6-12 months after operation (P>0.05). No children died, and no other clinical event was found.ConclusionThe Ozaki technique of reconstructing a tricuspid aortic valve leaflet for the treatment of severe aortic regurgitation in children is effective in short term, and the persistence of its valve function remains to be determined in the long-term follow-up.
ObjectiveTo analyze the risk factors and re-intervention strategies for mid- and long-term residual after arterial switch operation (ASO). MethodsThe clinical data of children with complex congenital heart disease who underwent ASO surgery in Shanghai Children’s Medical Center from January 2006 to June 2022 were retrospectively collected, and the factors for mid- and long-term residual after ASO were analyzed. ResultsA total of 952 children undergoing ASO were enrolled in this study, including 654 males and 298 females with an average age of 102.9±90.1 d and weight of 4.6±1.6 kg. There were 421 patients with D-transposition of the great arteries with intact ventricular septum (D-TGA/IVS), 357 patients with D-transposition of the great arteries with ventricular septal defect (D-TGA/VSD), and 174 patients with right ventricle double outlet combined with inferior pulmonary artery absence (Taussig-Bing malformation). Eighty-nine patients died early after the surgery, the mortality rate was 9.3%. The 746 surviving children were regularly followed up after the surgery (follow-up rate 86.4%), with a median follow-up time of 79.4 (12.0-188.0) months. During the follow-up, 53 children underwent surgical re-intervention due to residual, including 33 males and 20 females, with a median age of 62.5 (17.0-214.0) months. The median surgical weight was 19.0 (8.2-86.0) kg, and the mean time of re-intervention was 28.0-170.0 (77.5±45.4) months after the ASO. Residual problems included common trunk and branch stenosis of the pulmonary artery in 34 patients, right outflow tract stenosis in 11 patients, left outflow tract stenosis in 6 patients, aortic arch restenosis in 5 patients, aortic insufficiency in 5 patients, residual shunt of ventricular septal defect in 2 patients, and tricuspid valve insufficiency in 1 patient. Two patients died early after the re-intervention because of acute left heart failure, and the mortality rate was 3.8% (2/53). The mean follow-up time of the surviving children was 52.4±28.6 months, and no mid- and long-term death occurred. Two patients underwent the third operations due to pulmonary restenosis. The multivariate analysis result showed that combined aortic arch surgery and early postoperative right ventricular outlet tract (RVOT) velocity>3 m/s were independent risk factors for mid- and long-term residual after ASO. ConclusionASO is an ideal surgical method for the treatment of D-TGA/IVS, D-TGA/VSD and Taussig-Bing malformations. Combined aortic arch surgery and early postoperative RVOT velocity>3 m/s are independent risk factors for mid- and long-term residual after ASO.