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右心室至肺动脉管道手术及再次干预后的长期预后。

Long-term outcome after right ventricle to pulmonary artery conduit surgery and reintervention.

作者信息

Skoglund Kristofer, Svensson Gunnar, Thilén Ulf, Dellborg Mikael, Eriksson Peter

机构信息

a Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy , University of Gothenburg, Sahlgrenska University Hospital , Gothenburg , Sweden.

b Department of Cardiology , Lund University, Skåne University Hospital , Lund , Sweden.

出版信息

Scand Cardiovasc J. 2017 Oct;51(5):284-291. doi: 10.1080/14017431.2017.1343492. Epub 2017 Jun 23.

Abstract

BACKGROUND

Reconstruction of the right ventricular outflow tract with a conduit is an established surgical procedure in congenital heart disease and reinterventions are common.

OBJECTIVE

An increasing number of patients have a conduit, but there are few population-based studies of long-term outcomes after conduit surgery, reoperations, and transcatheter pulmonary valve replacement.

METHODS

In April 2015, all adult patients with a conduit were identified in the Swedish National Registry for Congenital Heart Disease (SWEDCON). Data on patients who died before age of 16 years are not included in the registry and thus not included in the study.

RESULTS

We found 574 patients with a mean age 36.1 years. The largest proportion had tetralogy of Fallot (45%). In total there were 762 operations and 50 transcatheter pulmonary valve replacements. Mean age at first conduit operation was 20.2 years. Long-term survival up to 48 years including perioperative mortality (<1%) was 93% at 20 years. The most common cause of death was cardiac-related. Higher age at first conduit operation was associated with increased mortality risk. Reintervention-free survival was 77% and 54% at 10 and 20 years, respectively. Conduit reinterventions were common. Ten-year reintervention-free survival after first conduit reintervention (n = 176) was significantly lower than after first conduit operation (70% vs 77% p = .04). Higher age at first conduit operation was associated with a reduced risk of reintervention, whereas male sex and complex malformations were associated with increased risk of reintervention.

CONCLUSIONS

The mortality of repeated conduit reinterventions is low. The need for reintervention of conduits is considerable, and reintervention-free survival after the first conduit reintervention is poorer than after first conduit implantation. The findings in this study only applies for patients reaching 16 years of age.

摘要

背景

使用管道重建右心室流出道是先天性心脏病的一种既定外科手术,再次干预很常见。

目的

越来越多的患者使用了管道,但基于人群的管道手术、再次手术和经导管肺动脉瓣置换术后长期结局研究较少。

方法

2015年4月,在瑞典先天性心脏病国家登记处(SWEDCON)识别出所有成年管道患者。16岁之前死亡患者的数据未纳入该登记处,因此也未纳入本研究。

结果

我们发现574例患者,平均年龄36.1岁。最大比例的患者患有法洛四联症(45%)。总共进行了762次手术和50次经导管肺动脉瓣置换。首次管道手术的平均年龄为20.2岁。包括围手术期死亡率(<1%)在内的长达48年的长期生存率在20年时为93%。最常见的死亡原因与心脏相关。首次管道手术时年龄较大与死亡风险增加相关。无再次干预生存率在10年和20年时分别为77%和54%。管道再次干预很常见。首次管道再次干预(n = 176)后10年无再次干预生存率显著低于首次管道手术后(70%对77%,p = 0.04)。首次管道手术时年龄较大与再次干预风险降低相关,而男性和复杂畸形与再次干预风险增加相关。

结论

重复管道再次干预的死亡率较低。管道再次干预的需求相当大,首次管道再次干预后的无再次干预生存率低于首次管道植入后。本研究结果仅适用于年满16岁的患者。

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