Mukadam Shireen, Gordon Brent M, Olson Jeffrey T, Newcombe Jennifer B, Hasaniya Nahidh W, Razzouk Anees J, Bailey Leonard L
1 Division of General Pediatrics, Department of Pediatrics, Loma Linda University Hospital, Loma Linda, CA, USA.
2 Division of Pediatric Cardiology, Department of Pediatrics, Loma Linda University Hospital, Loma Linda, CA, USA.
World J Pediatr Congenit Heart Surg. 2018 Sep;9(5):522-528. doi: 10.1177/2150135118776931.
Recurrence after surgical resection of discrete subvalvar aortic stenosis in children often requires repeat operation. Risk factors for recurrence are poorly understood. We sought to determine potential risk factors for recurrence and postoperative comorbidities in the long term.
Retrospective chart review was performed on all pediatric patients who underwent surgical resection of discrete subaortic stenosis at our institution. Demographics, perioperative findings, and clinical data were analyzed for predisposing factors.
From 1991 to 2015, a total of 104 patients underwent primary surgical resection of discrete subaortic stenosis. There were no postoperative deaths. Three (2.9%) patients required pacemaker implantation. Nine (8.4%) patients required repeat resection for recurrence of subaortic membrane over a median follow-up of 8.5 years (interquartile range: 5.9-13.5 years). Actuarial freedom from repeat resection was 100%, 94%, and 82% at one, five, and ten years, respectively. Repeat resection occurred more frequently in patients with genetic disease (37.5% vs 10.7%; P = .033) and preoperative mitral regurgitation (MR; 25% vs 1.2%; P < .001). Postoperative aortic insufficiency (AI) that was moderate or worse was associated with older age at the time of first resection (relative risk [RR]: 1.54, P < .05), moderate or severe preoperative AI (RR: 1.84, P = .002), and repeat resection of subaortic stenosis (RR: 1.90, P < .001).
The majority of children who undergo surgical resection of subaortic stenosis will not experience recurrence in childhood and those who do require repeat resection may have a higher incidence of genetic disease and preoperative MR. Postoperative AI is associated with repeat resection, older age at the time of surgery, and degree of preoperative AI.
儿童离散性瓣下主动脉狭窄手术切除后复发往往需要再次手术。复发的危险因素尚不清楚。我们试图确定长期复发和术后合并症的潜在危险因素。
对在我们机构接受离散性主动脉瓣下狭窄手术切除的所有儿科患者进行回顾性病历审查。分析人口统计学、围手术期发现和临床数据以寻找易感因素。
1991年至2015年，共有104例患者接受了离散性主动脉瓣下狭窄的初次手术切除。无术后死亡病例。3例（2.9%）患者需要植入起搏器。9例（8.4%）患者在中位随访8.5年（四分位间距：5.9 - 13.5年）后因主动脉瓣下膜复发需要再次切除。1年、5年和10年时无需再次切除的精算自由度分别为100%、94%和82%。遗传性疾病患者（37.5%对10.7%；P = 0.033）和术前二尖瓣反流（MR；25%对1.2%；P < 0.001）患者再次切除更为常见。中度或更严重的术后主动脉瓣关闭不全（AI）与首次切除时年龄较大（相对风险[RR]：1.54，P < 0.05）、术前中度或重度AI（RR：1.84，P = 0.002）以及主动脉瓣下狭窄再次切除（RR：1.90，P < 0.001）相关。
大多数接受主动脉瓣下狭窄手术切除的儿童在童年期不会复发，而那些确实需要再次切除的儿童可能遗传性疾病和术前MR的发生率较高。术后AI与再次切除、手术时年龄较大以及术前AI程度相关。
