Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College.
Psychological Teaching and Research Department, Hangzhou Armed Police Officer School.
Circ J. 2019 Feb 25;83(3):647-653. doi: 10.1253/circj.CJ-18-0916. Epub 2019 Feb 9.
Common atrioventricular valve (CAVV) repair in patients with a single ventricle remains a great challenge and a refractory issue for pediatric cardiac surgeons.
From January 2007 to April 2018, 37 consecutive patients with a single ventricle who underwent CAVV repair were included in the study group. Patients were divided into 2 groups based on the repair technique: patients in Group A were treated using the bivalvation technique, and patients in Group B underwent conventional repair techniques; baseline data were similar between groups. The inhospital and follow-up mortality were 5.4% (2/37) and 11.4% (4/35), respectively. After a follow-up of 65.5±29.3 months, the estimated 1-, 5-, and 10-year overall survival rates were 94.6%, 83.4%, and 77.0%, respectively. The rates of freedom from CAVV failure were 94.3%, 72.7%, and 62.9% after 1, 5, and 10 years, respectively. In the multivariate analysis, the independent factors for CAVV repair failure were repair technique (P=0.004) and heterotaxy syndrome (P=0.003). A total of 30 patients (81.1%) completed total cavopulmonary connection (TCPC); 3 patients required re-intervention; 24 of 31 patients (77.4%) were in New York Heart Association classes II and I at the latest follow-up.
Outcomes of CAVV repair in patients palliated by single-ventricular surgery are acceptable. The bivalvation technique is a simple and effective technique.
在单心室患者中进行常见的房室瓣（CAVV）修复仍然是小儿心脏外科医生面临的巨大挑战和难题。
从 2007 年 1 月至 2018 年 4 月，37 例接受 CAVV 修复的单心室患者纳入研究组。根据修复技术将患者分为 2 组：组 A 患者采用双瓣叶技术治疗，组 B 患者采用常规修复技术；组间基线数据相似。住院期间和随访死亡率分别为 5.4%（2/37）和 11.4%（4/35）。随访 65.5±29.3 个月后，估计 1 年、5 年和 10 年的总生存率分别为 94.6%、83.4%和 77.0%。1 年、5 年和 10 年时 CAVV 修复失败的无事件生存率分别为 94.3%、72.7%和 62.9%。多因素分析显示，CAVV 修复失败的独立因素是修复技术（P=0.004）和心脏异位综合征（P=0.003）。共有 30 例患者（81.1%）完成了全腔静脉肺动脉连接（TCPC）；3 例患者需要再次介入治疗；31 例患者中的 24 例（77.4%）在最近的随访中处于纽约心脏协会心功能分级 II 级和 I 级。
在单心室姑息手术患者中进行 CAVV 修复的结果是可以接受的。双瓣叶技术是一种简单有效的技术。
