Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Ann Thorac Surg. 2012 Mar;93(3):849-55. doi: 10.1016/j.athoracsur.2011.09.043. Epub 2012 Jan 23.
Long-term results of reoperation for left atrioventricular valve regurgitation (LAVVR) after previous correction of atrioventricular septal defect (AVSD) are scarce. We evaluated long-term outcome of reoperation for LAVVR and identified risk factors for reoperation.
Between December 1976 and July 2006, 45 of 312 patients with correction of different AVSDs underwent reoperation for LAVVR. The cohort of 267 patients who did not need reoperation for LAVVR allowed for the identification of risk factors for reoperation and evaluation of overall survival after primary AVSD repair in a competing risk scenario. Clinical data were obtained by retrospective review.
The left atrioventricular valve (LAVV) was repaired in 31 patients (68.9%) and replaced in 14 (31.1%). There were 3 in-hospital deaths (6.7%) and 2 late deaths (4.4%). Estimated overall survival was 88.1% at 15 years after the reoperation, and estimated incidence of death after reoperation in the total patient cohort was 2% at 15 years after the primary AVSD repair. Overall survival was significantly higher after LAVV repair than after replacement (p=0.010). Ten patients with LAVV repair required a second reoperation for LAVVR. At follow-up, survivors were in New York Heart Association functional class I (n=36) or II (n=4). Independent risk factors for first reoperation for LAVVR were associated cardiovascular anomalies (p<0.001), LAVV dysplasia (p<0.001), and nonclosure of the cleft (p=0.027).
After previous correction of AVSD, LAVVR can usually be corrected by valve repair. A very dysplastic valve may necessitate replacement. Overall survival is higher after repair than after replacement. In general, overall survival of patients reoperated on for LAVVR is favorable. The overall mortality rate after primary repair of AVSD is explained only for a small part by mortality after reoperation for LAVVR.
既往房室间隔缺损（AVSD）矫正术后再次行左房室瓣关闭不全（LAVVR）手术的长期结果资料较为匮乏。本研究旨在评估再次行 LAVVR 手术的长期结果，并识别再次手术的危险因素。
1976 年 12 月至 2006 年 7 月，312 例不同 AVSD 矫正患者中，45 例行 LAVVR 再次手术。在无再次手术需求的 267 例患者中，通过竞争风险分析识别再次手术的危险因素，并评估初次 AVSD 修复术后的总生存率。临床资料通过回顾性分析获得。
31 例（68.9%）患者行 LAVV 修复，14 例（31.1%）行 LAVV 置换。围术期死亡 3 例（6.7%），晚期死亡 2 例（4.4%）。再次手术后 15 年，总体生存率为 88.1%，初次 AVSD 修复后 15 年，全组患者的死亡率为 2%。LAVV 修复的总体生存率明显高于置换（p=0.010）。10 例行 LAVV 修复的患者因 LAVVR 再次行二次手术。随访时，存活患者纽约心功能分级为 I 级（n=36）或 II 级（n=4）。首次 LAVVR 再次手术的独立危险因素包括合并心血管畸形（p<0.001）、LAVV 发育不良（p<0.001）和房间隔未闭（p=0.027）。
既往 AVSD 矫正术后，LAVVR 通常可通过瓣膜修复矫正。严重发育不良的瓣膜可能需要置换。修复后的总体生存率高于置换。总体而言，LAVVR 再次手术患者的总体生存率较好。初次 AVSD 修复后总死亡率，仅能部分解释再次行 LAVVR 手术后的死亡率。
