Oosterhof Thomas, Meijboom Folkert J, Vliegen Hubert W, Hazekamp Mark G, Zwinderman Aeiko H, Bouma Berto J, van Dijk Arie P J, Mulder Barbara J M
Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands.
Eur Heart J. 2006 Jun;27(12):1478-84. doi: 10.1093/eurheartj/ehl033. Epub 2006 May 17.
To analyse the long-term outcomes after pulmonary valve replacement (PVR) in patients with a previous correction for tetralogy of Fallot.
In a retrospective study, 158 adult patients with a diagnosis of tetralogy of Fallot, who had undergone a PVR after initial total correction in childhood, were identified from the CONCOR (CONgenital CORvitia) registry. All patients underwent 175 PVRs between June 1986 and June 2005. To analyse the predictors for homograft dysfunction and adverse events (death, reoperations, balloon angioplasty), Cox-regression analysis was performed. Overall freedom from significant homograft dysfunction was 66% after 5 years and 47% after 10 years. We could not identify predictors for combined homograft dysfunction. Event-free survival was 78% at 10 years and 68% at 15 years after PVR. Both early significant pulmonary regurgitation (PR) (HR 6.8, P = 0.017) and pulmonary stenosis (PS) (HR 4.0, P = 0.037) after surgery were associated with adverse events. When analysing direct post-operative PR or PS, we observed that in patients with severe, pre-operative PR, right ventricular aneurysm/patch resection resulted in a lower post-operative PR (mean difference grade 0.38 +/- 0.14, P = 0.01). Less significant post-operative PS was associated with a higher diameter of the homograft (HR 0.37, P = 0.006).
While 47% of the patients in our study were free from homograft dysfunction at 10 years after PVR, event-free survival after PVR remained fairly good (78%). Significant residual lesions directly after surgery influenced event-free survival. A smaller diameter of the pulmonary homograft and severe pre-surgical PR were related to early homograft dysfunction after surgery.
分析曾接受法洛四联症矫治术的患者行肺动脉瓣置换术（PVR）后的长期预后。
在一项回顾性研究中，从CONCOR（先天性心脏病注册研究）登记处识别出158例诊断为法洛四联症的成年患者，这些患者在儿童期首次接受完全矫治术后又接受了PVR。1986年6月至2005年6月期间，所有患者共接受了175次PVR。为分析同种异体移植物功能障碍及不良事件（死亡、再次手术、球囊血管成形术）的预测因素，进行了Cox回归分析。5年后，无明显同种异体移植物功能障碍的总体发生率为66%，10年后为47%。我们未能确定同种异体移植物联合功能障碍的预测因素。PVR后10年的无事件生存率为78%，15年为68%。术后早期明显的肺动脉反流（PR）（风险比[HR]6.8，P = 0.017）和肺动脉狭窄（PS）（HR 4.0，P = 0.037）均与不良事件相关。在分析术后直接出现的PR或PS时，我们观察到，术前存在严重PR的患者，右心室动脉瘤/补片切除术可使术后PR降低（平均差异等级0.38±0.14，P = 0.01）。术后PS不太明显与同种异体移植物直径较大相关（HR 0.37，P = 0.006）。
虽然我们研究中47%的患者在PVR后10年无同种异体移植物功能障碍，但PVR后的无事件生存率仍相当不错（78%）。术后直接存在的明显残余病变影响无事件生存率。肺动脉同种异体移植物直径较小及术前严重PR与术后早期同种异体移植物功能障碍相关。
