Rizzoli G, Mazzucco A, Fracasso A, Stellin G, Rubino M, Gallucci V
Department of Cardiovascular Surgery, University of Padua, Italy.
Eur J Cardiothorac Surg. 1990;4(7):371-6; discussion 377-8. doi: 10.1016/1010-7940(90)90045-2.
Between January 1, 1975, and December 31, 1988, 233 patients were operated on for correction of tetralogy of Fallot (TOF). Mean follow-up was 13.9 years (median 7.65 years) and was 99.6% complete. Actuarial survival was 84 +/- 3%. The risk of death decreased gradually to a constant rate of 0.00034 deaths/month by the 6th postoperative month. There were 22 early deaths, due mostly to Low Output Syndrome. The principal incremental risk factor was the postrepair ventricular pressure ratio (PRV/LV) (P less than 0.0001). Other factors were: patent ductus arteriosus (PDA; P = 0.02), other associated anomalies (P = 0.005), higher preoperative hemoglobin levels (P = 0.06) and use of transannular patches (P = 0.02). The operative risk was significantly reduced by a recent operative date (P = 0.01) and by an older age at operation (P = 0.12). Among 8 late deaths, 2 were unrelated to the cardiac condition, 2 occurred suddenly, 3 were due to congestive heart failure and the last was due to reoperation for patch endocarditis. The risk of late death was significantly higher in patients operated on at an older age (P = 0.04). There were 10 open heart reoperations: 5 for patch dehiscence, 4 for residual pulmonary stenosis and 1 for residual atrial septal defect. The reoperation-free actuarial survival was 82 +/- 3%. With the present operative standards, the parametric operative risk of an average patient with simple TOF (hemoglobin = 12 g, PRV/LV = 0.5) is 0.7%. Where the TOF is severely cyanotic (hemoglobin = 25 g) and the pulmonary arteries are severely restricted, the average mortality is 30%.(ABSTRACT TRUNCATED AT 250 WORDS)
1975年1月1日至1988年12月31日期间，233例患者接受了法洛四联症（TOF）矫正手术。平均随访时间为13.9年（中位数7.65年），随访完整率为99.6%。精算生存率为84±3%。术后第6个月时，死亡风险逐渐降至恒定的每月0.00034例死亡。有22例早期死亡，主要原因是低心排血量综合征。主要的增加风险因素是修复后心室压力比（PRV/LV）（P＜0.0001）。其他因素包括：动脉导管未闭（PDA；P = 0.02）、其他相关畸形（P = 0.005）、术前血红蛋白水平较高（P = 0.06）以及使用跨环补片（P = 0.02）。近期手术日期（P = 0.01）和手术时年龄较大（P = 0.12）可显著降低手术风险。在8例晚期死亡中，2例与心脏疾病无关，2例突然发生，3例因充血性心力衰竭，最后1例因补片心内膜炎再次手术。年龄较大患者的晚期死亡风险显著更高（P = 0.04）。有10例心脏再次手术：5例因补片裂开，4例因残余肺动脉狭窄，1例因残余房间隔缺损。无再次手术的精算生存率为82±3%。按照目前的手术标准，单纯TOF（血红蛋白 = 12 g，PRV/LV = 0.5）的平均患者参数化手术风险为0.7%。当TOF严重发绀（血红蛋白 = 25 g）且肺动脉严重受限，平均死亡率为30%。（摘要截取自250字）
