M3C-Necker Enfants malades, AP-HP, Université de Paris, Paris, France; CRESS, INSERM, INRA, Université de Paris, Paris, France.
M3C-Necker Enfants malades, AP-HP, Université de Paris, Paris, France.
J Thorac Cardiovasc Surg. 2021 Oct;162(4):1205-1214.e2. doi: 10.1016/j.jtcvs.2020.10.147. Epub 2020 Nov 28.
We compared the risk of mortality and reintervention after common arterial trunk (CAT) repair for different surgical techniques, in particular the reconstruction of the right ventricle outflow tract with left atrial appendage (LAA) without a monocusp.
The study population comprised 125 patients with repaired CAT who were followed-up at our institution between 2000 and 2018. Statistical analysis included Cox proportional hazard models.
Median follow-up was 10.6 years. The 10-year survival rate was 88.2% (95% confidence interval [CI], 80.6-92.4) with the poorest outcome for CAT type IV (64.3%; 95% CI, 36.8-82.3; P < .01). In multivariable analysis, coronary anomalies (hazard ratio [HR], 11.63 [3.84-35.29], P < .001) and CAT with interrupted aortic arch (HR, 6.50 [2.10-20.16], P = .001) were substantial and independent risk factors for mortality. Initial repair with LAA was not associated with an increased risk of mortality (HR, 0.37 [0.11-1.24], P = .11). The median age at reintervention was 3.6 years [7.3 days-13.1 years]. At 10 years, freedom from reintervention was greater in the group with LAA repair compared with the valved conduit group, 73.3% (95% CI, 41.3-89.4) versus 17.2% (95% CI, 9.2-27.4) (P < .001), respectively. Using a valved conduit for repair (HR, 4.79 [2.45-9.39], P < .001), truncal valve insufficiency (HR, 2.92 [1.62-5.26], P < .001) and DiGeorge syndrome (HR, 2.01 [1.15-3.51], P = .01) were independent and clinically important risk factors for reintervention.
For the repair of CAT, the LAA technique for right ventricle outflow tract reconstruction was associated with comparable survival and greater freedom from reintervention than the use of a valved conduit.
我们比较了不同手术技术（尤其是不使用单乳头瓣重建右心室流出道的左心耳（LAA））治疗共同动脉干（CAT）修复术后的死亡率和再干预风险。
本研究纳入了 2000 年至 2018 年在我院接受治疗的 125 例 CAT 修复患者，随访至 2018 年。统计分析包括 Cox 比例风险模型。
中位随访时间为 10.6 年。10 年生存率为 88.2%（95%置信区间[CI]，80.6%-92.4%），CAT 型 IV 的预后最差（64.3%；95%CI，36.8%-82.3%；P<0.01）。多变量分析显示，冠状动脉异常（危险比[HR]，11.63[3.84-35.29]，P<0.001）和主动脉弓中断合并 CAT（HR，6.50[2.10-20.16]，P=0.001）是死亡率的显著独立危险因素。初始修复时使用 LAA 并不增加死亡率的风险（HR，0.37[0.11-1.24]，P=0.11）。再次干预的中位年龄为 3.6 岁[7.3 天-13.1 岁]。10 年时，与带瓣管道组相比，LAA 修复组的无再干预生存率更高，分别为 73.3%（95%CI，41.3%-89.4%）和 17.2%（95%CI，9.2%-27.4%）（P<0.001）。使用带瓣管道进行修复（HR，4.79[2.45-9.39]，P<0.001）、干骺端瓣膜关闭不全（HR，2.92[1.62-5.26]，P<0.001）和 DiGeorge 综合征（HR，2.01[1.15-3.51]，P=0.01）是再干预的独立且具有重要临床意义的危险因素。
对于 CAT 的修复，与使用带瓣管道相比，LAA 技术重建右心室流出道与生存结局相当，但无再干预的比例更高。
