Heart Centre for Children, Children's Hospital at Westmead, Sydney, Australia; The University of Sydney Children's Hospital Westmead Clinical, Children's Hospital at Westmead, Sydney, Australia.
School of Public Health, Curtin University, Perth, Australia.
J Thorac Cardiovasc Surg. 2020 Mar;159(3):1014-1025.e8. doi: 10.1016/j.jtcvs.2019.08.005. Epub 2019 Aug 30.
To evaluate whether the long-term outcomes of modified-single-patch (MSP) repair of complete atrioventricular septal defect are equivalent to double-patch (DP) repair with respect to survival and risk of reoperation for left atrioventricular valve regurgitation or left ventricular outflow tract obstruction.
All patients who underwent biventricular repair of complete atrioventricular septal defect in Australia from 1990 to 2015 using either a MSP or DP technique were identified. Demographic characteristic details, operative data, and outcomes were analyzed. A propensity score analysis was performed to balance the 2 treatment groups according to several baseline covariates. Survival and freedom from reintervention between the 2 groups were compared using Kaplan-Meier curves and log-rank tests.
A total of 819 patients underwent repair of complete atrioventricular septal defect (252 MSP and 567 DP) during the study period. There was no significant difference in unmatched survival (P = .85) and event-free survival (P = .49) between MSP and DP repair. Propensity score matching resulted in a total of 223 matched pairs. Matched analysis found no difference in overall survival (P = .59) or event-free survival (P = .90) between repair techniques, with an estimated event-free survival at 5, 10, and 15 years of 83%, 83%, and 74% for DP and 83%, 80%, and 77% for the MSP group, respectively. There was no significant difference between repair techniques in reoperation for left atrioventricular valve regurgitation or left ventricular outflow tract obstruction or need for permanent pacemaker.
Overall and event free survival are similar following either MSP or DP repair of complete atrioventricular septal defect. There is no increased risk of reoperation for left ventricular outflow tract obstruction with the MSP technique.
评估改良单片修补术（MSP）与双片修补术（DP）治疗完全性房室间隔缺损的长期结果，比较两种术式在左房室瓣反流或左心室流出道梗阻再手术风险方面的差异。
在澳大利亚，1990 年至 2015 年间所有接受双心室修复的完全性房室间隔缺损患者，按修补术式分为 MSP 组和 DP 组。分析患者的人口统计学特征、手术数据和结果。采用倾向评分分析，根据多项基线协变量对两组进行均衡。采用 Kaplan-Meier 曲线和对数秩检验比较两组患者的生存和无再干预情况。
研究期间共有 819 例患者接受完全性房室间隔缺损修补术（MSP 组 252 例，DP 组 567 例）。两组患者在未匹配的生存率（P=0.85）和无事件生存率（P=0.49）方面无显著差异。倾向评分匹配后共得到 223 对匹配患者。配对分析发现，两组患者的总生存率（P=0.59）和无事件生存率（P=0.90）均无差异，DP 组和 MSP 组的估计无事件生存率在 5、10 和 15 年时分别为 83%、83%和 74%，83%、80%和 77%。两组患者的左房室瓣反流或左心室流出道梗阻再手术或需要永久性起搏器的比例无显著差异。
MSP 或 DP 修复完全性房室间隔缺损的总体生存率和无事件生存率相似。MSP 技术不会增加左心室流出道梗阻的再手术风险。
