Naimo Phillip S, Yong Matthew S, d'Udekem Yves, Brizard Christian P, Kelly Andrew, Weintraub Robert, Konstantinov Igor E
Royal Children's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
Royal Children's Hospital, Melbourne, Australia.
Ann Thorac Surg. 2014 Nov;98(5):1674-9. doi: 10.1016/j.athoracsur.2014.06.043. Epub 2014 Sep 8.
The purpose of this study was to assess the outcomes of children undergoing repair of aortopulmonary window (APW).
We conducted a retrospective review of all children (n=43) who underwent surgical repair of APW between 1980 and 2013.
Median age at surgery was 40 days (range, 13 to 125). Simple APW was present in 15 of 43 patients (35%), and 28 of 43 patients (65%) patients had concomitant cardiovascular anomalies. The aorta was repaired by direct suturing in 36 patients (84%) patients and patching in 7 patients (16%). The main pulmonary artery was repaired by direct suturing in 22 patients (51%) patients and by patching in 21 (49%). Cardiopulmonary bypass was used in 42 of the 43 patients (97.7%). Single-staged repair of concomitant cardiovascular anomalies was undertaken in 26 of 28 patients (93%). Only 2 of the 28 patients (7%) underwent repair of interrupted aortic arch before APW repair. Operative mortality was 6.7% (1 of 15 patients) among patients with simple APW and 18% (5 of 28 patients) among patients with concomitant anomalies. Operative weight less than 2.5 kg was associated with mortality on univariable analysis (p=0.02). Median follow-up was 10.1 years (range, 0.17 to 24.2). There were no late deaths. Overall survival was 86% (95% confidence interval: 71.3 to 94.2) at 10 years. Freedom from reoperation was 95.3% (95% confidence interval: 86.2 to 99.9) at 10 years. At last follow-up, all patients were in New York Heart Association functional class I/II.
Survival beyond discharge from the hospital is associated with excellent outcomes.
本研究的目的是评估接受主肺动脉窗（APW）修复术的儿童的手术结果。
我们对1980年至2013年间接受APW手术修复的所有儿童（n = 43）进行了回顾性研究。
手术时的中位年龄为40天（范围13至125天）。43例患者中有15例（35%）为单纯APW，43例患者中有28例（65%）伴有心血管畸形。36例（84%）患者的主动脉通过直接缝合修复，7例（16%）患者通过补片修复。22例（51%）患者的主肺动脉通过直接缝合修复，21例（49%）通过补片修复。43例患者中有42例（97.7%）使用了体外循环。28例伴有心血管畸形的患者中有26例（93%）进行了单阶段修复。28例患者中只有2例（7%）在APW修复术前进行了主动脉弓中断修复。单纯APW患者的手术死亡率为6.7%（15例中的1例），伴有畸形患者的手术死亡率为18%（28例中的5例）。单因素分析显示手术体重小于2.5 kg与死亡率相关（p = 0.02）。中位随访时间为10.1年（范围0.17至24.2年）。无晚期死亡病例。10年时的总生存率为86%（95%置信区间：71.3至94.2）。10年时无需再次手术的比例为95.3%（95%置信区间：86.2至99.9）。在最后一次随访时，所有患者的心功能分级均为纽约心脏协会I/II级。
出院后的生存率与良好的手术结果相关。
