Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Division of Congenital Heart Surgery, Texas Children's Hospital, Houston, Texas; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Ann Thorac Surg. 2021 Jun;111(6):2021-2027. doi: 10.1016/j.athoracsur.2020.06.118. Epub 2020 Sep 16.
Multiple techniques exist for the repair of supravalvular aortic stenosis (SVAS), but given the lesion's rarity, analyses comparing the efficacy of each repair have been limited.
A retrospective review of all children at a single institution who underwent repair of SVAS from June 1995 to May 2019 was performed. Anatomic and physiologic measurements across time points were compared between 2 predominant surgical techniques. Time-to-event outcomes were compared using the log-rank test.
SVAS was repaired in 89 patients, by using a single-patch in 31 (35%) and the Doty repair in 58 (65%). Median age at operation was 2.5 years (interquartile range [IQR], 1.0 to 6.8 years), with median follow-up of 5.8 years (IQR, 1.8 to 10.7 years). Reoperation was required in 8 (9%) patients at a median of 1.5 years postoperatively (IQR, 0.3 to 4.8 years). There was 1 death after multiple reinterventions. The change from the preoperative to the postoperative sinotubular junction z-score was greater for patients after Doty repair (median change +2.5; IQR, 1.5, 4.1) than for patients after single-patch repair (median change +0.8; IQR, -0.1, 2.1; P = .001). Freedom from reoperation was longer for patients after Doty repair than after the single-patch technique (P = .008).
The Doty repair provides longer freedom from reoperation after supravalvular aortic stenosis repair compared with a single-patch technique, likely through a greater increase in the sinotubular junction at the time of initial operation.
多种技术可用于修复瓣上型主动脉狭窄（SVAS），但鉴于该病变的罕见性，比较每种修复方法疗效的分析受到限制。
对 1995 年 6 月至 2019 年 5 月期间在单一机构接受 SVAS 修复的所有儿童进行了回顾性分析。在两种主要手术技术之间比较了不同时间点的解剖和生理测量值。使用对数秩检验比较生存时间结果。
31 例（35%）采用单补丁修复，58 例（65%）采用 Doty 修复，共 89 例患者接受了 SVAS 修复。手术时的中位年龄为 2.5 岁（四分位距[IQR]，1.0 至 6.8 岁），中位随访时间为 5.8 年（IQR，1.8 至 10.7 年）。术后中位随访 1.5 年（IQR，0.3 至 4.8 年）时，8 例（9%）患者需要再次手术。多次再干预后有 1 例死亡。与单补丁修复相比，Doty 修复术后患者的窦管交界区 z 评分从术前到术后的变化更大（中位数变化+2.5；IQR，1.5，4.1），而单补丁修复术后患者的变化中位数为+0.8；IQR，-0.1，2.1；P=0.001）。Doty 修复组患者免于再次手术的时间长于单补丁修复组（P=0.008）。
与单补丁技术相比，Doty 修复术在修复瓣上型主动脉狭窄后，免于再次手术的时间更长，这可能是由于初次手术时窦管交界区的变化更大。
