Alqurashi Gadah M, Almohanna Rema S, Ayoub Kamal M K, Alkhuraiji Arwa A, Almasoud Najla A, Alsubaie Amjad R, Althubaiti Alaa M, Al Sehly Abdullah A
College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
King Abdulaziz Cardiac Center, National Guard Health Affairs, Riyadh, Saudi Arabia.
J Saudi Heart Assoc. 2020 Aug 19;32(3):358-364. doi: 10.37616/2212-5043.1045. eCollection 2020.
The purpose of this study is to measure the incidence of recurrence of discrete subaortic stenosis (DSS) after primary resection in two major cardiac centers in Saudi Arabia and to identify risk factors associated with recurrence.
Data on 234 patients who were diagnosed with DSS and underwent surgical resection between 1999 and 2018 were retrospectively reviewed. Patient demographics as well as echocardiographic, surgical, and pathological data were compared between patients with recurrence and non-recurrence.
The overall recurrence incidence after primary resection was 44.87% (N = 105). Most patients were male (59%). The median age at the 1 operation was 60 months (range 3 months to 133 months). The presence of aortic stenosis at the time of diagnosis was significantly associated with recurrence (p-value = 0.002). The overall median peak gradient in which the primary resection was indicated is 60 mmHg (range 11 to 152 mmHg). The median peak gradient pre-operation and post-operation were significantly higher for the recurrence group (p-value=0.018 and p<0.001, respectively). We used univariate and multivariate analysis and controlled for the follow-up time, but there were no significant independent predictors of recurrence.
The recurrence rate of DSS after the primary resection is relatively high in this study. Further prospective studies are needed to draw a definite conclusion on risk factors for recurrence after primary resection.
本研究旨在测量沙特阿拉伯两个主要心脏中心原发性切除术后离散性主动脉瓣下狭窄（DSS）的复发率，并确定与复发相关的危险因素。
回顾性分析1999年至2018年间234例诊断为DSS并接受手术切除患者的数据。比较复发患者和未复发患者的人口统计学数据以及超声心动图、手术和病理数据。
原发性切除术后的总体复发率为44.87%（n = 105）。大多数患者为男性（59%）。首次手术时的中位年龄为60个月（范围3个月至133个月）。诊断时存在主动脉瓣狭窄与复发显著相关（p值 = 0.002）。表明需要进行原发性切除的总体中位峰值梯度为60 mmHg（范围11至152 mmHg）。复发组术前和术后的中位峰值梯度显著更高（p值分别为0.018和<0.001）。我们使用单因素和多因素分析并控制随访时间，但没有复发的显著独立预测因素。
本研究中，原发性切除术后DSS的复发率相对较高。需要进一步的前瞻性研究以得出关于原发性切除术后复发危险因素的确切结论。
