Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China.
J Thorac Cardiovasc Surg. 2010 Apr;139(4):950-5. doi: 10.1016/j.jtcvs.2009.05.047. Epub 2009 Oct 23.
Our aim was to test whether a unidirectional valve patch would provide benefit to early and long-term survival for patients with ventricular septal defect and severe pulmonary artery hypertension.
Eight hundred seventy-six cases of ventricular septal defect with severe pulmonary artery hypertension were closed with or without a unidirectional valve patch and were classified as the unidirectional valve patch (UVP) group (n = 195) and nonvalve patch (NVP) group (n = 681), respectively. Propensity scores of inclusion into the UVP group were used to match 138 pairs between the 2 groups. Kaplan-Meier survival curves were constructed to compare early and long-term survival.
For the 138 propensity-matched pairs, there were 7 and 9 early deaths (in-hospital deaths) in the UVP and NVP groups, respectively. The difference in early mortality between the 2 groups did not reach statistical significance (chi(2) = 0.265, P = .6064). With a mean of 9.2 +/- 4.92 years' and 2511 patient-years' follow-up, there were 6 late deaths in the UVP group and 7 late deaths in the NVP group. The difference in actuarial survival at 5, 10, 15, and 18 years between the 2 groups was not significant (log-rank test, chi(2) = 0.565, P = .331). The difference in the late mortality between the groups with or without a patent patch at the time of discharge did not reach statistical significance (chi(2) = 1.140, P = .2856). There was no difference between the 2 groups in the 6-minute walk distance assessed at the last follow-up (525.9 +/- 88.0 meters for the UVP group and 536.5 +/- 95.8 meters for the NVP group, F = 1.550, P = .214).
A unidirectional valve patch provides no benefits to early and long-term survival when it is used to deal with ventricular septal defect and severe pulmonary artery hypertension.
本研究旨在探讨单向活瓣补片在治疗室间隔缺损合并重度肺动脉高压患者中的应用是否能够提高早期和长期生存率。
876 例室间隔缺损合并重度肺动脉高压患者分别采用或不采用单向活瓣补片行缺损修补术，分为单向活瓣补片（UVP）组（n=195）和非活瓣补片（NVP）组（n=681）。采用倾向性评分匹配法对 UVP 组进行 138 对匹配。绘制 Kaplan-Meier 生存曲线比较两组的早期和长期生存情况。
在 138 对倾向性评分匹配的患者中，UVP 组和 NVP 组的早期死亡（院内死亡）分别为 7 例和 9 例，两组早期死亡率差异无统计学意义（χ²=0.265，P=0.6064）。UVP 组平均随访 9.2±4.92 年，共 2511 患者年，有 6 例患者死亡；NVP 组平均随访 9.2±4.92 年，共 2511 患者年，有 7 例患者死亡。两组患者在 5、10、15 和 18 年的生存曲线 actuarial 无显著差异（log-rank 检验，χ²=0.565，P=0.331）。出院时存在或不存在活瓣补片的两组之间的晚期死亡率差异无统计学意义（χ²=1.140，P=0.2856）。最后一次随访时两组 6 分钟步行距离（UVP 组 525.9±88.0 米，NVP 组 536.5±95.8 米，F=1.550，P=0.214）无差异。
在治疗室间隔缺损合并重度肺动脉高压时，使用单向活瓣补片不能提高早期和长期生存率。
