Division of Congenital Heart Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas.
Division of Congenital Heart Surgery, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas.
Ann Thorac Surg. 2018 Nov;106(5):1429-1437. doi: 10.1016/j.athoracsur.2018.06.006. Epub 2018 Oct 4.
Contemporary outcomes of complete atrioventricular septal defect (CAVSD) repair, particularly for defects with associated abnormalities, is unclear. The goal of this study is to report an all-inclusive experience of CAVSD repair using a consistent surgical approach.
All patients undergoing CAVSD repair between 1995 and 2016 at our institution were included. Patients were divided into 2 groups: isolated and complex (tetralogy of Fallot, aortic arch repair, double outlet right ventricle, and total anomalous pulmonary venous return). Survival and reoperation were analyzed using log-rank test and Gray's test, respectively. Multivariable analysis was performed with Cox regression.
Overall, 406 patients underwent repair: 350 (86%) isolated and 56 (14%) complex CAVSD (tetralogy of Fallot: 34, double outlet right ventricle: 7, aortic arch repair: 12, total anomalous pulmonary venous return: 3). Median age at repair was 5 months (range, 10 days to 16 years); 339 (84%) had trisomy 21. A 2-patch repair was used in 395 (97%) and the zone of apposition was completely closed in 305 (75%). Perioperative mortality was 2% and 4% in the isolated and complex groups, respectively. Perioperative mortality since 2006 was 0.9%. Median follow-up was 7 years. Overall 10-year survival and incidence of any reoperation were 92% and 11%, respectively. Complex anatomy was not a risk factor for mortality (p = 0.35), but it was for reoperation (hazard ratio [HR]: 2.6; p < 0.01). Risk factors for left atrioventricular valve reoperation were a second bypass run (HR: 2.7) and preoperative moderate or worse regurgitation (HR: 2.3).
Mortality after CAVSD repair is low, yet reoperation remains a significant problem. Repair of complex CAVSD can be performed with similar mortality rates.
完全性房室间隔缺损（CAVSD）修复的当代结果，特别是对于伴有相关异常的缺陷，尚不清楚。本研究的目的是报告使用一致的手术方法治疗 CAVSD 的全面经验。
本研究纳入了 1995 年至 2016 年期间在我院接受 CAVSD 修复的所有患者。患者分为两组：单纯组和复杂组（法洛四联症、主动脉弓修复、右心室双出口和完全性肺静脉异位引流）。使用对数秩检验和 Gray 检验分别分析生存率和再次手术率。使用 Cox 回归进行多变量分析。
总体而言，406 例患者接受了修复手术：350 例（86%）为单纯性 CAVSD，56 例（14%）为复杂性 CAVSD（法洛四联症：34 例，右心室双出口：7 例，主动脉弓修复：12 例，完全性肺静脉异位引流：3 例）。修复时的中位年龄为 5 个月（范围：10 天至 16 岁）；339 例（84%）存在 21 三体。395 例（97%）采用 2 补丁修复，305 例（75%）完全关闭吻合区。单纯组和复杂组的围手术期死亡率分别为 2%和 4%。2006 年以来，围手术期死亡率为 0.9%。中位随访时间为 7 年。总体 10 年生存率和任何再次手术发生率分别为 92%和 11%。复杂解剖结构不是死亡的危险因素（p=0.35），但却是再次手术的危险因素（风险比[HR]：2.6；p<0.01）。左房室瓣再次手术的危险因素包括第二次旁路运行（HR：2.7）和术前中度或更严重反流（HR：2.3）。
CAVSD 修复后的死亡率较低，但再次手术仍然是一个重要问题。复杂 CAVSD 的修复可以达到相似的死亡率。
