Department of Echocardiography, State Key Laboratory of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiac Surgery, Peking University International Hospital, Beijing, China.
Eur J Cardiothorac Surg. 2021 Jun 14;59(6):1312-1319. doi: 10.1093/ejcts/ezab110.
The purpose of this study was to review the outcomes of surgical treatment in patients with aorto-left ventricular tunnel and to investigate what kind of patient cohort is more likely to have adverse events.
Twenty-one patients with a median age of 6.58 [interquartile range (IQR) 4.17-24.50] years who received surgical treatment of aorto-left ventricular tunnel from March 2002 to December 2019 were reviewed. The median follow-up time was 64.50 (IQR 25.15-120.50) months. Clinical characteristics, surgical methods and follow-up outcomes were summarized in separate groups of patients with or without preoperative aortic valve (AoV) issues. Composite adverse events were defined as death or requirement of reoperation. Time-related analysis of freedom from death and requirement of reoperation was performed with the Kaplan-Meier method.
The average tunnel size was 8.68 (standard deviation: 3.62) mm. The most common and the most important associated lesions were AoV lesions. Tunnels in 20 patients were closed with direct sutures or a patch. For 1 patient with an irreparable AoV, the tunnel was cut open simultaneously with aortic valve replacement and aortic root plasty. In the group of patients with preoperative AoV issues, 4 patients received aortic valve replacement with mechanical prosthetic valves and 6 patients received aortic valvuloplasty repair. The follow-up outcomes differed significantly between groups (the incidence of death was 15.38% and the incidence of requiring a reoperation was 46.15% in patients with preoperative AoV issues). In the group without preoperative AoV issues, there were no deaths and no reoperations (Fisher's exact test; P = 0.018). The probability of freedom from death and of the requirement for reoperation between the 2 groups was not significantly different (log-rank, P = 0.09). Overall, the estimated probability of freedom from death and requirement of reoperation was 77.30% (standard error: 10.20%) [95% confidence interval (CI): 49.53-91.00] at 5 years, 67.64% (standard error: 12.70%) (95% CI: 36.71-85.84) at 10 years.
Patients with aorto-left ventricular tunnel with preoperative AoV issues are more prone to die or to require a reoperation. In contrast, patients without preoperative AoV issues can be free from death or reoperation for a longer period of time. Patients with preoperative AoV issues need much stricter postoperative long-term echocardiographic follow-up.
本研究旨在回顾主动脉-左心室隧道患者的手术治疗结果，并探讨哪种患者群体更有可能发生不良事件。
回顾 2002 年 3 月至 2019 年 12 月期间接受主动脉-左心室隧道手术治疗的 21 例年龄中位数为 6.58（四分位距 [IQR] 4.17-24.50）岁的患者。中位随访时间为 64.50（IQR 25.15-120.50）个月。总结了有或无术前主动脉瓣（AoV）问题的患者的临床特征、手术方法和随访结果。复合不良事件定义为死亡或需要再次手术。采用 Kaplan-Meier 法进行无死亡和再次手术要求的时间相关分析。
平均隧道大小为 8.68（标准差：3.62）mm。最常见和最重要的相关病变是 AoV 病变。20 例患者的隧道用直接缝合或补片关闭。对于 1 例 AoV 不可修复的患者，同时进行隧道切开、主动脉瓣置换和主动脉根部成形术。在术前有 AoV 问题的患者组中，4 例患者接受机械人工瓣膜主动脉瓣置换，6 例患者接受主动脉瓣成形术修复。两组随访结果差异有统计学意义（术前有 AoV 问题组的死亡率为 15.38%，再次手术率为 46.15%）。在没有术前 AoV 问题的组中，无死亡和再次手术（Fisher 确切检验；P=0.018）。两组间无死亡和再次手术要求的概率无显著差异（对数秩检验，P=0.09）。总体而言，两组患者的 5 年无死亡和再次手术要求的估计概率为 77.30%（标准误差：10.20%）[95%可信区间（CI）：49.53-91.00]，10 年为 67.64%（标准误差：12.70%）（95%CI：36.71-85.84）。
术前有 AoV 问题的主动脉-左心室隧道患者更易死亡或需要再次手术。相比之下，没有术前 AoV 问题的患者可以更长时间地避免死亡或再次手术。术前有 AoV 问题的患者需要更严格的术后长期超声心动图随访。
