Stulak John M, Burkhart Harold M, Dearani Joseph A
Division of Cardiovascular Surgery, Mayo Clinic and Foundation, Rochester, MN, USA.
World J Pediatr Congenit Heart Surg. 2010 Apr;1(1):97-104. doi: 10.1177/2150135110362453.
The most common cause of reoperation following repair of atrioventricular septal defect (AVSD) is left atrioventricular valve regurgitation. However, reoperation for subaortic obstruction is required in some, especially after initial repair of partial AVSD. Etiology of reoperation and late outcome were evaluated. Between 1962 and 2007, 146 patients (59 male) underwent reoperation at the authors' institution after prior repair of partial (n = 96) and complete (n = 50) AVSD. Median age at reoperation after repair of partial AVSD was 26 years (range, 10 months to 71 years) and 4.5 years (range, 53 days to 38 years) after repair of complete AVSD. The 3 most common indications for reoperation included left atrioventricular (AV) valve regurgitation in 105 patients, subaortic stenosis in 29, and right AV valve regurgitation in 21. The most common procedures performed included left AV valve repair in 59 (40%) patients, left AV valve replacement in 56 (38%), subaortic fibrous resection/myectomy in 24 (16%), and right AV valve surgery in 19 (13%). Freedom from subsequent reoperation at 10 years was 48% after initial repair of complete AVSD and 84% after initial repair of partial AVSD. During late follow-up, 10-year actuarial survival was 91% and 77% after initial repair of complete and partial AVSD, respectively. The most common indication for reoperation after initial repair of partial or complete AVSD is left AV valve pathology; left ventricular outflow tract obstruction was more common in partial AVSD. Although freedom from subsequent reoperations is higher after initial repair of partial AVSD, these patients have reduced long-term survival when compared with complete AVSD.
房室间隔缺损（AVSD）修复术后再次手术最常见的原因是左房室瓣反流。然而，部分患者需要再次手术治疗主动脉瓣下梗阻，尤其是部分AVSD初次修复术后。对再次手术的病因及远期预后进行了评估。1962年至2007年期间，146例患者（59例男性）在作者所在机构接受了部分（n = 96）和完全（n = 50）AVSD初次修复术后的再次手术。部分AVSD修复术后再次手术的中位年龄为26岁（范围10个月至71岁），完全AVSD修复术后为4.5岁（范围53天至38岁）。再次手术最常见的3个指征包括105例患者的左房室（AV）瓣反流、29例的主动脉瓣下狭窄和21例的右AV瓣反流。最常进行的手术包括59例（40%）患者的左AV瓣修复、56例（38%）的左AV瓣置换、24例（16%）的主动脉瓣下纤维切除术/心肌切除术和19例（13%）的右AV瓣手术。完全AVSD初次修复术后10年无再次手术的概率为48%，部分AVSD初次修复术后为84%。在远期随访中，完全和部分AVSD初次修复术后10年的精算生存率分别为91%和77%。部分或完全AVSD初次修复术后再次手术最常见的指征是左AV瓣病变；左心室流出道梗阻在部分AVSD中更常见。虽然部分AVSD初次修复术后再次手术的概率较高，但与完全AVSD相比，这些患者的长期生存率较低。
