小儿先天性冠状动脉瘘：介入治疗与外科治疗的对比。
Congenital coronary artery fistula in pediatric patients: transcatheter versus surgical closure.
机构信息
The First Affiliated Hospital of Shantou University Medical College, Shantou, China.
Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan 2nd Road, Yuexiu District, Guangzhou, 510000, China.
出版信息
BMC Cardiovasc Disord. 2020 Nov 16;20(1):484. doi: 10.1186/s12872-020-01769-7.
OBJECTIVES
Transcatheter closure (TCC) and surgical closure (SC) are the two main approaches for congenital coronary artery fistula (CCAF), but data on the comparisons of the efficacy and safety of these two approaches are limited.
METHODS
We retrospectively reviewed pediatric patients with CCAF in Guangdong Cardiovascular Institute between January 2002 and December 2017. Patients who were qualified into our criteria were included into final analysis. The rate of successful closure and complications during hospitalization and at follow-up were compared between SC and TCC groups.
RESULTS
In total, 121 pediatric patients (male, n = 69; female, n = 52) with CCAF were divided to TCC (n = 63) and SC groups (n = 58) according to the indications. The mean age was 5.3 ± 1.4 years. The baseline characteristics of these two groups were similar except for the fistula anatomic feature. After adjusted for the fistula anatomy, compared to SC, TCC was associated with higher risk of major complications (p = 0.013). Proportions of patients requiring blood transfusion and intra-operative blood loss were higher in SC versus TCC groups, as were longer duration of hospital and ICU stay during hospitalization. In contrast, myocardial ischemia (10.2% vs 0.0%, p = 0.028), residual shunts (16.9% vs 3.6%, p = 0.045) and new-onset moderate-to-severe valve regurgitation (11.9% vs 0.0%, p = 0.013) were higher in TCC group versus SC groups during follow-up.
CONCLUSIONS
TCC has less invasive and faster recovery. However, SC had a higher successful rate and lower risk of major complications in pediatric patients.
目的
经导管封堵（TCC）和外科封堵（SC）是先天性冠状动脉瘘（CCAF）的两种主要治疗方法，但关于这两种方法疗效和安全性比较的数据有限。
方法
我们回顾性分析了 2002 年 1 月至 2017 年 12 月期间在广东省心血管病研究所接受治疗的小儿 CCAF 患者。符合纳入标准的患者纳入最终分析。比较 SC 组和 TCC 组患者的封堵成功率和住院及随访期间的并发症发生率。
结果
共 121 例小儿 CCAF 患者（男 69 例，女 52 例）根据适应证分为 TCC 组（n=63）和 SC 组（n=58）。平均年龄为 5.3±1.4 岁。两组患者的基线特征除瘘管解剖特征外无差异。在调整瘘管解剖因素后，与 SC 相比，TCC 与主要并发症风险较高相关（p=0.013）。SC 组患者输血和术中失血量比例、住院和 ICU 住院时间均高于 TCC 组，而心肌缺血（10.2% vs 0.0%，p=0.028）、残余分流（16.9% vs 3.6%，p=0.045）和新发中重度瓣膜反流（11.9% vs 0.0%，p=0.013）在 TCC 组更高。
结论
TCC 具有微创和更快恢复的优势。然而，SC 在小儿患者中具有更高的成功率和较低的主要并发症风险。
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