Vida Vladimiro L, Tessari Chiara, Castaldi Biagio, Padalino Massimo A, Milanesi Ornella, Gregori Dario, Stellin Giovanni
Paediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
Paediatric Cardiology Unit, Department of Child and Woman's Health, University of Padua, Padua, Italy.
Ann Thorac Surg. 2016 Dec;102(6):2044-2051. doi: 10.1016/j.athoracsur.2016.09.020. Epub 2016 Oct 27.
Over the past 20 years our policy has been to electively repair common atrioventricular canal defects (CAVCD) in patients between 8 and 12 weeks of age. We sought to evaluate the results of our past 20-year experience.
From January 1992 to April 2014, 159 consecutive patients underwent CAVCD repair (133 patients had complete CAVCD and 26 patients had a transitional form of CAVCD).
Surgical repair was accomplished with a double-patch (n = 137 [86%]) or a modified single patch (n = 22 [14%]) technique. Median age at operation was 96 days (interquartile range [IQR], 73-128 days); 90 patients were younger than 3 months of age. There were 3 operative (1.9%) and 12 late (7.7%) deaths. Median follow-up time after repair was 8.2 years (IQR, 3.6-15 years). Twenty patients (13%) required reoperation-16 (10%) for left atrioventricular valve (LAVV) regurgitation. Reoperation on the LAVV was more frequent in patients with a dysplastic LAVV preoperatively (p = 0.01; odds ratio [OR], 4.2; 95% confidence interval [CI], 1.33-13.5) and in patients who underwent closure for an absent/incomplete cleft at the time of repair (p = 0.01; OR, 5.4; 95% CI, 1.4-21). Late LAVV performance (regurgitation greater than or equal to moderate or the need for reoperation), including late deaths and patients who underwent reoperation, was significantly worse in patients older than 3 months at repair (10 of 83 patients [12%] versus 20 of 73 patients [27%]; hazard ratio [HR], 2.71; 95% CI, 1.19-6.19) and in patients with LAVV dysplasia (19 of 68 patients [28%] versus 11 of 88 patients [12%]; HR, 3; 95% CI, 1.53-8.51).
Individualized early repair of CAVCD is safe and beneficial, with good early and long-term results.
在过去20年里，我们的政策是选择性地为年龄在8至12周的患者修复共同房室通道缺损（CAVCD）。我们试图评估过去20年的经验结果。
从1992年1月至2014年4月，159例连续患者接受了CAVCD修复（133例患者为完全性CAVCD，26例患者为过渡型CAVCD）。
手术修复采用双补片技术（n = 137 [86%]）或改良单补片技术（n = 22 [14%]）。手术时的中位年龄为96天（四分位间距[IQR]，73 - 128天）；90例患者年龄小于3个月。有3例手术死亡（1.9%）和12例晚期死亡（7.7%）。修复后的中位随访时间为8.2年（IQR，3.6 - 15年）。20例患者（13%）需要再次手术——16例（10%）因左房室瓣（LAVV）反流。术前LAVV发育异常的患者（p = 0.01；比值比[OR]，4.2；95%置信区间[CI]，1.33 - 13.5）以及在修复时因无/不完全性瓣裂而进行闭合的患者（p = 0.01；OR，5.4；95% CI，1.4 - 21）中，LAVV再次手术更为频繁。修复时年龄大于3个月的患者（83例患者中的10例[12%] 对比73例患者中的20例[27%]；风险比[HR]，2.71；95% CI，1.19 - 6.19）以及LAVV发育异常的患者（68例患者中的19例[28%] 对比88例患者中的11例[12%]；HR，3；95% CI，1.53 - 8.51）中，LAVV的晚期表现（反流大于或等于中度或需要再次手术），包括晚期死亡和接受再次手术的患者，明显更差。
CAVCD的个体化早期修复是安全且有益的，具有良好的早期和长期结果。
