接受初次或再次体循环房室瓣手术的先天性心脏病成年患者的结局及预后因素
Outcomes and Prognostic Factors for Adult Patients With Congenital Heart Disease Undergoing Primary or Reoperative Systemic Atrioventricular Valve Surgery.
作者信息
Stephens Elizabeth H, Han Jiho, Ginns Jonathan, Rosenbaum Marlon, Chai Paul, Bacha Emile, Kalfa David
机构信息
1 Division of Cardiac, Thoracic, and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, Morgan Stanley Children's Hospital, New York Presbyterian, Columbia University Medical Center, New York, NY, USA.
2 Department of Adult Congenital Heart Disease, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY, USA.
出版信息
World J Pediatr Congenit Heart Surg. 2017 May;8(3):346-353. doi: 10.1177/2150135117692974.
BACKGROUND
Adults with congenital heart disease (ACHD) undergoing systemic atrioventricular valve (SAVV) surgery are a complex, understudied population. We assessed midterm outcomes and prognostic factors in ACHD undergoing SAVV surgery.
METHODS
We performed retrospective evaluation of ACHD undergoing SAVV surgery from January 2005 to February 2016: 14 (33%) patients with congenital mitral valve stenosis/regurgitation, 15 (35%) with atrioventricular septal defect (AVSD), and 14 (33%) with congenitally corrected transposition of the great arteries (ccTGA) with systemic tricuspid valve regurgitation. Adverse events were defined as mortality, reoperation on SAVV, and late more-than-moderate (> moderate) SAVV regurgitation. Statistical analysis was performed using Fisher's exact test and one-way analysis of variance as well as univariate and multivariate risk factor analysis.
RESULTS
Fifteen (35%) patients had preoperative systemic ventricular dysfunction, including 13 patients with ccTGA (93%, P < .001). Twenty-three (54%) patients underwent valve repair, 20 (47%) patients underwent replacement, and 20 (47%) patients underwent an associated procedure. Replacement was higher in patients with ccTGA (86%) than the other groups ( P < 0.01). Thirty-seven patients (91% of survivors) were free of significant SAVV regurgitation at last follow-up, with patients with AVSD having greater regurgitation grades compared to the other groups ( P < 0.01). In-hospital mortality, late mortality, late > moderate SAVV regurgitation, and SAVV reoperation rates were 5% (n = 2), 2% (n = 1), 9% (n = 3), and 7% (n = 3), respectively. On multivariate analysis, predischarge SAVV regurgitation grade was the only significant predictor of adverse events (odds ratio = 8.2, 95% confidence interval: 1.1-63.8, P = .045).
CONCLUSION
Overall outcomes in this challenging population are good. The single factor associated with adverse events was predischarge SAVV regurgitation grade.
背景
接受体循环房室瓣（SAVV）手术的先天性心脏病成年患者是一个复杂且研究不足的群体。我们评估了接受SAVV手术的先天性心脏病成年患者的中期结局和预后因素。
方法
我们对2005年1月至2016年2月期间接受SAVV手术的先天性心脏病成年患者进行了回顾性评估：14例（33%）患有先天性二尖瓣狭窄/反流，15例（35%）患有房室间隔缺损（AVSD），14例（33%）患有大动脉转位矫正型（ccTGA）并伴有体循环三尖瓣反流。不良事件定义为死亡、SAVV再次手术以及晚期中重度以上（>中度）SAVV反流。采用Fisher精确检验、单因素方差分析以及单因素和多因素危险因素分析进行统计分析。
结果
15例（35%）患者术前存在体循环心室功能障碍，其中13例为ccTGA患者（93%，P <.001）。23例（54%）患者接受了瓣膜修复，20例（47%）患者接受了瓣膜置换，20例（47%）患者接受了相关手术。ccTGA患者的瓣膜置换率（86%）高于其他组（P < 0.01）。在最后一次随访时，37例患者（91%的幸存者）无明显SAVV反流，与其他组相比，AVSD患者的反流程度更高（P < 0.01）。住院死亡率、晚期死亡率、晚期中重度以上SAVV反流率和SAVV再次手术率分别为5%（n = 2）、2%（n = 1）、9%（n = 3）和7%（n = 3）。多因素分析显示，出院前SAVV反流程度是不良事件的唯一显著预测因素（比值比 = 8.2，95%置信区间：1.1 - 63.8，P =.045）。
结论
这一具有挑战性群体的总体结局良好。与不良事件相关的单一因素是出院前SAVV反流程度。
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