Division of Pediatric Cardiothoracic Surgery and Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA.
Ann Thorac Surg. 2011 Oct;92(4):1468-75; discussion 1475. doi: 10.1016/j.athoracsur.2011.04.109. Epub 2011 Aug 26.
The influence of atrioventricular septal defect (AVSD) subtype on outcomes after repair is poorly understood.
Demographic, procedural, and outcome data were obtained 1 and 6 months after AVSD repair in an observational study conducted at 7 North American centers.
The 215 AVSD patients were subtyped as 60 partial, 27 transitional, 120 complete, and 8 with canal-type VSD. Preoperatively, transitional patients had the highest prevalence of moderate or severe left atrioventricular valve regurgitation (LAVVR, p = 0.01). At repair, complete AVSD and canal-type VSD patients, both with the highest prevalence of trisomy 21 (p < 0.001), were younger (p < 0.001), had lower weight-for-age z scores (p = 0.005), and had more associated cardiac defects (p < 0.001). Annuloplasty was similar among subtypes (p = 0.91), with longer duration of ventilation and hospitalization for complete AVSD (p < 0.001). Independent predictors of moderate or severe LAVVR at the 6-month follow-up were older log(age) at repair (p = 0.02) but not annuloplasty, subtype, or center (p > 0.4). Weight-for-age z scores improved in all subtypes at the 6-month follow-up, and improvement was similar among subtypes (p = 0.17).
AVSD subtype was significantly associated with patient characteristics and clinical status before repair and influenced age at repair. Significant postoperative LAVVR is the most common sequela, with a similar prevalence across centers 6 months after the intervention. Annuloplasty failed to decrease the postoperative prevalence of moderate or severe LAVVR at 6 months. After accounting for age at repair, AVSD subtype was not associated with postoperative LAVVR severity or growth failure at 6 months. Further investigation is needed to determine if interventional strategies specific to AVSD subtype improve surgical outcomes.
房室间隔缺损（AVSD）亚型对修复后结局的影响知之甚少。
在北美 7 个中心进行的观察性研究中，于 AVSD 修复后 1 个月和 6 个月时获取人口统计学、程序和结局数据。
215 例 AVSD 患者分为 60 例部分型、27 例过渡型、120 例完全型和 8 例管型 VSD。术前，过渡型患者左房室瓣反流（LAVVR）中度或重度的发生率最高（p = 0.01）。在修复时，完全型和管型 VSD 患者均为 21 三体发生率最高（p < 0.001），年龄更小（p < 0.001），体重-年龄 z 评分更低（p = 0.005），且伴有更多相关心脏缺陷（p < 0.001）。各亚型的环缩术相似（p = 0.91），但完全型 AVSD 的通气时间和住院时间更长（p < 0.001）。6 个月随访时中度或重度 LAVVR 的独立预测因素为修复时年龄的对数（log(age)）较大（p = 0.02），而非环缩术、亚型或中心（p > 0.4）。6 个月随访时所有亚型的体重-年龄 z 评分均有改善，且各亚型之间的改善相似（p = 0.17）。
AVSD 亚型与修复前患者特征和临床状况显著相关，并影响修复时的年龄。术后严重的 LAVVR 是最常见的后遗症，术后 6 个月时各中心的发生率相似。环缩术未能降低术后 6 个月时中度或重度 LAVVR 的发生率。在考虑修复时的年龄后，AVSD 亚型与术后 6 个月时的 LAVVR 严重程度或生长不良无关。需要进一步研究以确定针对 AVSD 亚型的干预策略是否能改善手术结局。
