Kasnar-Samprec Jelena, Hörer Jürgen, Bierwirth Hanna, Prodan Zsolt, Cleuziou Julie, Eicken Andreas, Lange Rüdiger, Schreiber Christian
Department of Cardiovascular Surgery, Deutsches Herzzentrum München an der Technischen Universität München, 80636, Munich, Germany.
Pediatr Cardiol. 2012 Oct;33(7):1131-7. doi: 10.1007/s00246-012-0267-y. Epub 2012 Mar 22.
We sought to evaluate whether the presence of pulmonary stenosis (PS), amongst other factors, influences the mortality and the rate of reoperations in the long-term follow-up of patients with supravalvular aortic stenosis (SVAS). We identified all patients with SVAS from our surgical database. The patients with multi-level aortic stenosis or concomitant cardiac procedures were excluded from this study. Follow-up (100 %) was conducted between 2008 and 2010. Twenty-six patients underwent surgery for SVAS between 1974 and 2006. Seventeen patients (65 %) were diagnosed with Williams-Beuren-Syndrome, six (17 %) had a diffuse form of SVAS and 10 (39 %) had PS. No patient had a surgical or interventional procedure for PS at the initial operation or during follow-up. There was no statistically significant association between PS and WBS (p = 0.30) or diffuse form of SVAS (p = 0.13). Patients with PS were operated at younger age (p = 0.028). Median follow-up time was 14.6 years. Overall mortality was 11.5 %. One patient with preoperatively severely decreased LV-function died 27 days postoperatively. Two late deaths occurred 7 and 10 years after the initial operation. Reoperations were required in 4 patients (15 %), 4-19 years after the original operation, due to aortic arch stenosis, supravalvular restenosis or poststenotic aortic dilatation. PS was found to be a risk factor for reoperation (p = 0.005) and for the combined reoperation/death end-point (p = 0.003). PS in patients with SVAS is a risk factor for reoperations in the aortic region and might be considered an indicator of the severity of the arterial disease and a predictor of an unfavourable outcome.
我们试图评估在其他因素中,肺动脉狭窄(PS)的存在是否会影响主动脉瓣上狭窄(SVAS)患者长期随访中的死亡率和再次手术率。我们从手术数据库中识别出所有SVAS患者。多级主动脉狭窄或同期心脏手术患者被排除在本研究之外。随访(100%)于2008年至2010年进行。1974年至2006年期间,26例患者接受了SVAS手术。17例患者(65%)被诊断为威廉姆斯-贝伦综合征,6例(17%)患有弥漫性SVAS,10例(39%)患有PS。在初次手术或随访期间,没有患者因PS接受手术或介入治疗。PS与威廉姆斯-贝伦综合征(p = 0.30)或弥漫性SVAS(p = 0.13)之间无统计学显著关联。患有PS的患者手术时年龄较小(p = 0.028)。中位随访时间为14.6年。总死亡率为11.5%。1例术前左心室功能严重下降的患者术后27天死亡。初次手术后7年和10年发生2例晚期死亡。4例患者(15%)在初次手术后4至19年因主动脉弓狭窄、瓣上再狭窄或狭窄后主动脉扩张需要再次手术。PS被发现是再次手术的危险因素(p = 0.005)和再次手术/死亡联合终点的危险因素(p = 0.003)。SVAS患者中的PS是主动脉区域再次手术的危险因素,可能被视为动脉疾病严重程度的指标和不良结局的预测因素。