Binsalamah Ziyad M, Spigel Zachary A, Zhu Huirong, Kim Mary B, Chacon-Portillo Martin A, Adachi Iki, Imamura Michiaki, Mery Carlos M, Mckenzie Emmett Dean, Fraser Charles D, Heinle Jeffrey S
Division of Congenital Heart Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
Division of Outcomes and Impact Services, Texas Children's Hospital, Houston, TX, USA.
Cardiol Young. 2019 Nov;29(11):1391-1396. doi: 10.1017/S1047951119002336. Epub 2019 Sep 26.
The resection of a subaortic membrane remains far from a curative operation. We sought to examine factors associated with reoperation and the degree of aortic valve regurgitation as a potential long-term source for reoperation.
All patients who underwent resection of an isolated subaortic membrane between 1995 and 2018 were included. Patients who underwent other procedures were excluded. Paired categorical data were compared using McNemar's test. Univariate time-to-event analyses were performed using Kaplan-Meier methods with log-rank tests for categorical variables and univariate Cox models for continuous variables.
A total of 84 patients (median age 6.6, 31% females) underwent resection of isolated subaortic membrane. At a median follow-up of 9.3 years (interquartile range 0.6-22.5), 12 (14%) patients required one reoperation and 1 patient required two reoperations. Median time to first reoperation was 4.6 years. The degree of aortic valve regurgitation improved post-operatively from pre-operatively (p = 0.0007); however, the degree of aortic valve regurgitation worsened over the course of follow-up (p = 0.010) to equivalence with pre-operative aortic valve regurgitation (p = 0.18). Performance of a septal myectomy was associated with longer freedom from reoperation (p = 0.004).
In patients with isolated subaortic membranes, performance of a septal myectomy can minimise risk for reoperation. Patients should be serially monitored for degradation of the aortic valve, even if aortic regurgitation is not present post-operatively.
主动脉瓣下隔膜切除术远非根治性手术。我们试图研究与再次手术相关的因素以及主动脉瓣反流程度，后者是再次手术潜在的长期原因。
纳入1995年至2018年间接受孤立性主动脉瓣下隔膜切除术的所有患者。排除接受其他手术的患者。配对分类数据采用McNemar检验进行比较。单变量事件发生时间分析采用Kaplan-Meier方法，分类变量用对数秩检验，连续变量用单变量Cox模型。
共有84例患者（中位年龄6.6岁，31%为女性）接受了孤立性主动脉瓣下隔膜切除术。中位随访9.3年（四分位间距0.6 - 22.5年），12例（14%）患者需要进行一次再次手术，1例患者需要进行两次再次手术。首次再次手术的中位时间为4.6年。主动脉瓣反流程度术后较术前有所改善（p = 0.0007）；然而，在随访过程中主动脉瓣反流程度恶化（p = 0.010），至与术前主动脉瓣反流程度相当（p = 0.18）。间隔心肌切除术与再次手术的无复发生存期延长相关（p = 0.004）。
对于孤立性主动脉瓣下隔膜患者，进行间隔心肌切除术可将再次手术风险降至最低。即使术后不存在主动脉反流，也应对患者进行主动脉瓣退变的系列监测。
