State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Cardiol Young. 2021 Mar;31(3):391-399. doi: 10.1017/S1047951120004047. Epub 2020 Nov 19.
This study aimed to investigate the association between long-term survival and different management of major aortopulmonary collateral arteries in patients with pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries.
From November, 2009 to October, 2018, a total of 98 consecutive patients with pulmonary atresia, ventricular septal defect, major aortopulmonary collateral arteries, and hypoplastic pulmonary arteries treated with modified Blalock-Taussig shunt or right ventricle-pulmonary artery connection were included. Fifty-five patients who received occlusion or ligation of major aortopulmonary collateral arteries during or after palliative procedure were occlusion group, and the other 43 patients were no occlusion group. The early and late outcomes were compared.
The mean duration of follow-up was 30.9 months in no occlusion group and 49.8 months in the occlusion group (p < 0.001). Multivariate analysis showed that only no occlusion of major aortopulmonary collateral arteries was predictive of total mortality (Hazard Ratio: 4.42, 95% CI: 1.27 to 15.42, p = 0.02). The Kaplan-Meier survival curves confirmed that patients without occlusion of major aortopulmonary collateral arteries demonstrated worse survival as compared with the occlusion group (p = 0.013). The Kaplan-Meier survival curves of patients who underwent different palliative procedures showed no differences.
For patients with pulmonary atresia, ventricular septal defect and major aortopulmonary collateral arteries when a primary repair is not feasible, those without occlusion of major aortopulmonary collateral arteries have a higher risk of death following an initial palliative procedure compared with patients who underwent occlusion of major aortopulmonary collateral arteries. The occlusion of major aortopulmonary collateral arteries is not associated with a higher rate of complete repair or better improvement of pulmonary artery growth.
本研究旨在探讨不同主肺动脉侧支血管处理方式与肺动脉闭锁、室间隔缺损伴主肺动脉侧支血管患儿长期生存的关系。
2009 年 11 月至 2018 年 10 月，共纳入 98 例接受改良 Blalock-Taussig 分流术或右心室肺动脉连接术治疗的肺动脉闭锁、室间隔缺损伴主肺动脉侧支血管及肺动脉发育不良患者。55 例在姑息性手术过程中或之后行主肺动脉侧支血管闭塞或结扎的患者为闭塞组，其余 43 例为未闭塞组。比较两组的近期和远期结局。
未闭塞组的平均随访时间为 30.9 个月，闭塞组为 49.8 个月（p＜0.001）。多因素分析显示，仅主肺动脉侧支血管未闭塞是全因死亡率的预测因素（风险比：4.42，95%可信区间：1.27 至 15.42，p=0.02）。Kaplan-Meier 生存曲线证实，与闭塞组相比，未闭塞主肺动脉侧支血管的患者生存状况较差（p=0.013）。不同姑息性手术患者的 Kaplan-Meier 生存曲线无差异。
对于不能行一期根治术的肺动脉闭锁、室间隔缺损伴主肺动脉侧支血管患儿，与行主肺动脉侧支血管闭塞术的患者相比，未行主肺动脉侧支血管闭塞术的患儿在初次姑息性手术后死亡风险更高。主肺动脉侧支血管闭塞术与完全修复率的升高或肺动脉生长改善无关。
