Pediatric Cardiac Surgery Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Department of Cardiovascular Surgery, The First Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China.
Ann Thorac Surg. 2022 Apr;113(4):1239-1247. doi: 10.1016/j.athoracsur.2021.03.015. Epub 2021 Mar 18.
Surgical outcomes for primary pulmonary vein stenosis (PPVS) remain unfavorable, and risk factors are still poorly understood. This study evaluated outcomes and risk factors after PPVS repair.
This retrospective study included 40 patients with PPVS who underwent surgical repair in Fuwai Hospital from 2010 to 2020. Adverse outcomes included overall death, pulmonary vein (PV) restenosis, and reintervention. A univariate and multivariate risk analysis was performed to determine risk factors.
The mean follow-up duration was 37.5 ± 31.5 months. Sutureless technique was performed in 7 patients (17.5%), endovenectomy in 9 (22.5%), and patch venoplasty in 24 (60%). Bilateral PV involvement was documented in 12 patients (30%). Overall death, PV reintervention, and restenosis occurred in 15%, 12.5%, and 25% of patients, respectively. Freedom from overall death, PV reintervention, and restenosis at 5 years was 85% ± 6.3%, 88.9% ± 5.2%, and 65.1% ± 13.2%, respectively. Multivariate analysis revealed that bilateral PV involvement was an independent risk factor for death or PV reintervention (hazard ratio, 10.4; 95% confidence interval, 1.9-56; P = .006) and that involvement of the left inferior PV was an independent risk factor for postoperative restenosis of the left inferior PV (hazard ratio, 13.1; 95% confidence interval, 2.2-76.8; P = .004).
Surgical treatment for PPVS remains a challenging issue with imperfect prognosis. Therefore, it is right and appropriate to take close surveillance on mild or moderate stenosis on a single PV. Bilateral and left inferior PV involvement are independent risk factors for adverse outcomes.
原发性肺静脉狭窄（PPVS）的手术结果仍然不理想，其风险因素仍知之甚少。本研究评估了 PPVS 修复后的结果和风险因素。
本回顾性研究纳入了 2010 年至 2020 年期间在阜外医院接受手术修复的 40 例 PPVS 患者。不良结果包括总死亡率、肺静脉（PV）再狭窄和再次干预。进行了单变量和多变量风险分析，以确定风险因素。
平均随访时间为 37.5 ± 31.5 个月。7 例（17.5%）采用无缝线技术，9 例（22.5%）采用经静脉切除术，24 例（60%）采用补片静脉成形术。12 例（30%）存在双侧 PV 受累。总死亡率、PV 再次干预和再狭窄分别发生在 15%、12.5%和 25%的患者中。5 年时无总死亡率、PV 再次干预和再狭窄的生存率分别为 85%±6.3%、88.9%±5.2%和 65.1%±13.2%。多变量分析显示，双侧 PV 受累是死亡或 PV 再次干预的独立危险因素（风险比，10.4；95%置信区间，1.9-56；P =.006），而左下肺静脉受累是左下肺静脉术后再狭窄的独立危险因素（风险比，13.1；95%置信区间，2.2-76.8；P =.004）。
PPVS 的手术治疗仍然是一个具有不理想预后的具有挑战性的问题。因此，对单个 PV 的轻度或中度狭窄进行密切监测是正确和适当的。双侧和左下肺静脉受累是不良结局的独立危险因素。
