Section of Cardiology, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio; Division of Pediatric Cardiology, Mayo Clinic College of Medicine, Rochester, Minnesota.
Department of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
Am J Cardiol. 2014 Aug 1;114(3):463-7. doi: 10.1016/j.amjcard.2014.05.020. Epub 2014 May 17.
Surgical repair of partial atrioventricular septal defects (AVSD) has been successful for more than 60 years. However, recent data from the Pediatric Heart Network show that 31% of patients have moderate or severe left atrioventricular valve regurgitation (LAVVR) at follow-up. Previously, our institution found that only 9% of patients had more than moderate LAVVR at the last follow-up. Our objective was to determine the long-term outcomes after repair of partial AVSD in the current era. We reviewed all patients with partial AVSD who had primary biventricular repair from January 1995 to June 2011 at our institution. The Kaplan-Meier method was used to estimate the survival free of an event, and factors were evaluated for an association with each outcome using the log-rank test. All 105 patients with partial AVSD who had surgery during this period were evaluated. The median age at surgery was 7.9 years. The overall survival rate at 1 year was 97%. Median follow-up was 5.3 years (interquartile range 1.7 to 11.1). At 3 years, the survival rate free from reoperation was 89%. Thirteen patients required reoperations with the most common reason being LAVVR. A total of 10 patients developed more than moderate LAVVR with a cumulative incidence of 8% by 2 years. The discrepancy with the Pediatric Heart Network data may be due to the later age of operation for patients in our cohort suggesting that elective repair of partial AVSD should be deferred until children are somewhat older (ages 5 to 8 years). Neither patient age (p = 0.11) nor severity of preoperative LAVVR (p = 0.16) were identified as statistically significant risk factors. In conclusion, there is less morbidity and mortality after surgical repair for partial AVSD.
部分房室间隔缺损（AVSD）的外科修复已经成功实施了 60 多年。然而，最近来自儿科心脏网络的数据显示，31%的患者在随访时存在中度或重度左房室瓣反流（LAVVR）。此前，我们机构发现，最后一次随访时只有 9%的患者存在中度以上 LAVVR。我们的目的是确定在当前时代修复部分 AVSD 的长期结果。我们回顾了我院 1995 年 1 月至 2011 年 6 月期间所有接受过双心室修复术的部分 AVSD 患者。使用 Kaplan-Meier 方法估计无事件生存，使用对数秩检验评估每个结局与因素的相关性。在此期间接受手术的 105 例部分 AVSD 患者均接受评估。手术时的中位年龄为 7.9 岁。1 年总体生存率为 97%。中位随访时间为 5.3 年（四分位间距 1.7 至 11.1）。3 年时，无再次手术的生存率为 89%。13 例患者需要再次手术，最常见的原因是 LAVVR。共有 10 例患者发展为中度以上 LAVVR，2 年时累积发病率为 8%。与儿科心脏网络数据的差异可能是由于我们队列中的患者手术年龄较晚，这表明应在儿童稍大一些（5 至 8 岁）时择期修复部分 AVSD。患者年龄（p=0.11）和术前 LAVVR 的严重程度（p=0.16）均不是统计学上显著的危险因素。总之，部分 AVSD 的外科修复后发病率和死亡率较低。
