Generali Tommaso, El Sayed Shady, Rao Vinay, Pardo Carlos, Congiu Stefano, Jaber Osama, van Doorn Carin
Department of Congenital Cardiac Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
J Card Surg. 2018 Aug;33(8):458-465. doi: 10.1111/jocs.13766. Epub 2018 Jul 2.
Left atrio-ventricular valve (LAVV) regurgitation after repair of an atrio-ventricular septal defect (AVSD) may necessitate further surgery. However, redo-LAVV repair remains challenging. We sought to determine if more LAVV valves are preserved in the current era, and analyze early and longer-term results.
All consecutive patients with repaired AVSD who underwent redo-LAVV surgery from January 2004 to April 2017 were included. Patients with single ventricles, atrial isomerism, and complex associated anomalies were excluded.
This was a single-center study using retrospective chart review and an institutional database for follow-up information. Data analyzed included number and year of primary AVSD and redo-LAVV operation, presence of trisomy 21, morphology of AVSD, mortality, and reoperation. Univariate analysis included repair and replacement rates and early and long-term survival.
During the study period 36 redo-LAVV operations were performed, with repair in 28 and replacement in eight. The number of redo-operations increased from 13 in the first part to 23 in the second part of the study. The rate of LAVV preservation significantly increased over time (54% vs 91%, P < 0.01), and was not affected by morphology of AVSD or trisomy 21. There was one in-hospital death at Day 42 and overall estimated survival was 94.5% at 5 years. Freedom from reoperation after redo-LAVV repair was 87% at 5 years with no significant difference between repair and replacement groups.
In the current era, more LAVVs can be preserved at the time of redo-operation with excellent early and long-term survival and acceptable reoperation rates. LAVV morphology and presence of trisomy 21 did not affect outcome.
房室间隔缺损（AVSD）修复术后的左房室瓣（LAVV）反流可能需要进一步手术。然而，再次进行LAVV修复仍然具有挑战性。我们试图确定在当前时代是否保留了更多的LAVV瓣膜，并分析早期和长期结果。
纳入了2004年1月至2017年4月期间接受再次LAVV手术的所有连续性AVSD修复患者。排除单心室、心房异构和复杂相关畸形的患者。
这是一项单中心研究，使用回顾性病历审查和机构数据库获取随访信息。分析的数据包括初次AVSD和再次LAVV手术的数量和年份、21三体的存在、AVSD的形态、死亡率和再次手术情况。单因素分析包括修复和置换率以及早期和长期生存率。
在研究期间进行了36次再次LAVV手术，其中28次进行了修复，8次进行了置换。再次手术的数量从研究第一部分的13次增加到第二部分的23次。LAVV保留率随时间显著增加（54%对91%，P＜0.01），且不受AVSD形态或21三体的影响。有1例在第42天住院死亡，5年时总体估计生存率为94.5%。再次LAVV修复术后5年无再次手术的自由度为87%，修复组和置换组之间无显著差异。
在当前时代，再次手术时可以保留更多的LAVV瓣膜，具有良好的早期和长期生存率以及可接受的再次手术率。LAVV形态和21三体的存在不影响结果。
