动脉调转手术后成年期新主动脉根部扩张和新主动脉瓣反流的时间进程及预测因素
Time course and predictors for neoaortic root dilatation and neoaortic valve regurgitation during adult life after arterial switch operation.
作者信息
Rueda Soriano Joaquín, Rodríguez Puras María José, Buendía Fuentes Francisco, Wals Rodríguez Amadeo, Osa Sáez Ana, Pulido Ildefonso, Agüero Ramón-Llin Jaime, Manso García Begoña, Insa Albert Beatriz, Navarro Silvia, Martínez-Dolz Luis, Gallego Pastora
机构信息
Unidad de Cardiopatías Congénitas del Adulto, Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, CIBERCV, Valencia, Spain.
Unidad de Cardiopatías Congénitas del Adulto, Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Instituto BioMedicina (IBIS), CIBERCV, Sevilla, Spain.
出版信息
Rev Esp Cardiol (Engl Ed). 2021 Apr;74(4):329-336. doi: 10.1016/j.rec.2020.01.022. Epub 2020 May 10.
INTRODUCTION AND OBJECTIVES
There are limited data on the long-term development of neoaortic root dilatation (NRD) and neoaortic valve regurgitation (AR) after arterial switch operation (ASO) for transposition of the great arteries during adult life.
METHODS
We performed a retrospective longitudinal analysis of 152 patients older than 15 years who underwent ASO for transposition of the great arteries and who were followed-up for 4.9±3.3 years in 2 referral centers. Sequential changes in body surface-adjusted aortic root dimensions and progression to moderate/severe AR were determined in patients with 2 or more echocardiographic examinations. Risk factors for dilatation were tested by Cox regression to identify predictors of AR progression.
RESULTS
At baseline, moderate AR was present in 9 patients (5.9%) and severe AR in 4 (2.6%), of whom 3 had required aortic valve surgery. Initially, the median neoaortic root dimension was 20.05±2.4mm/m, which increased significantly to 20.73±2.8mm/m (P <.001) at the end of follow-up. The mean change over time was 0.14mm/m/y (95%CI, 0.07-0.2). Progressive AR was observed in 20 patients (13.5%) and 6 patients (4%) required aortic valve surgery. Progressive AR was associated with bicuspid valve, AR at baseline, NRD at baseline, and neoaortic root enlargement. Independent predictors were bicuspid valve (HR, 3.3; 95%CI, 1.1-15.2; P=.037), AR at baseline (HR, 5.9; 95%CI, 1.6-59.2; P=.006) and increase in NRD (HR, 4.1 95%CI, 2-13.5; P=.023).
CONCLUSIONS
In adult life, NRD and AR progress over time after ASO. Predictors of progressive AR are bicuspid valve, AR at baseline, and increase in NRD.
引言与目的
关于大动脉转位患者在成年期接受动脉调转术（ASO）后新主动脉根部扩张（NRD）和新主动脉瓣反流（AR）的长期发展情况，相关数据有限。
方法
我们对152例年龄超过15岁、因大动脉转位接受ASO且在2个转诊中心接受了4.9±3.3年随访的患者进行了回顾性纵向分析。对有2次或更多次超声心动图检查的患者，测定体表面积校正后的主动脉根部尺寸的连续变化以及进展为中度/重度AR的情况。通过Cox回归检验扩张的危险因素，以确定AR进展的预测因素。
结果
基线时，9例患者（5.9%）存在中度AR，4例患者（2.6%）存在重度AR，其中3例曾接受主动脉瓣手术。最初，新主动脉根部尺寸中位数为20.05±2.4mm/m²，随访结束时显著增加至20.73±2.8mm/m²（P<.001）。随时间的平均变化为0.14mm/m²/年（95%CI，0.07 - 0.2）。20例患者（13.5%）出现进行性AR，6例患者（4%）需要接受主动脉瓣手术。进行性AR与二叶式瓣膜、基线时的AR、基线时的NRD以及新主动脉根部扩大有关。独立预测因素为二叶式瓣膜（HR，3.3；95%CI，1.1 - 15.2；P =.037）、基线时的AR（HR，5.9；95%CI，1.6 - 59.2；P =.006）以及NRD增加（HR，4.1；95%CI，2 - 13.5；P =.023）。
结论
在成年期，ASO后NRD和AR会随时间进展。进行性AR的预测因素为二叶式瓣膜、基线时的AR以及NRD增加。
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