Kwak Jae Gun, Shin Hong Ju, Bang Ji Hyun, Kim Eung Re, Lee Jeong Ryul, Kim Woong Han, Bae Eun Jung, Song Mi Kyoung, Kim Gi Beom
Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
Korean Circ J. 2021 Apr;51(4):360-372. doi: 10.4070/kcj.2020.0331.
We reviewed the long-term outcomes after tetralogy of Fallot (TOF) repair with trans-annular incision; and evaluated the effectiveness of pulmonary valve replacement (PVR) on outcomes.
This was a retrospective review of clinical outcomes of 180 of 196 TOF patients who underwent total correction with trans-annular incision from 1991 to 1997 (PVR group: 81; non-PVR group: 99).
The median age of the patients was 14.0 months (interquartile range [IQR], 10.7-19.8 months) at TOF repair. Ten in-hospital deaths (5.1%) occurred. During the follow-up, 81 patients underwent PVR at the median age of 13.5 years (IQR, 11.2-17.1 years). The patients in PVR group showed better outcomes than non-PVR group in overall survival rate (100% in PVR vs. 88.7% in non-PVR, p=0.007), in all adverse events (arrhythmia, neurologic complications, 95.5% in PVR vs. 74.6% in non-PVR, p=0.024) at 20 years. Age at TOF repair younger than 1 year (hazard ratio [HR], 2.265; p=0.01) and previous shunt history (HR, 2.195; p=0.008) were predictive for requiring PVR. During follow-up, 10 late deaths (5 sudden deaths) occurred in the non-PVR group, mainly due to ventricular arrhythmia and right ventricular failure; there was 1 late death (not a sudden death) in the PVR group.
Long-term survival after repair of TOF with trans-annular incision were acceptable. However, arrhythmias were frequently observed during 20 years of follow-up. The patient age <1 year at the time of TOF repair and shunt implantation prior to TOF repair were predictive factors for requiring PVR.
我们回顾了采用跨环切口修复法洛四联症（TOF）后的长期预后情况；并评估了肺动脉瓣置换术（PVR）对预后的有效性。
这是一项对1991年至1997年间接受跨环切口完全矫正术的196例TOF患者中的180例临床预后的回顾性研究（PVR组：81例；非PVR组：99例）。
TOF修复时患者的中位年龄为14.0个月（四分位间距[IQR]，10.7 - 19.8个月）。发生了10例住院死亡（5.1%）。在随访期间，81例患者在中位年龄13.5岁（IQR，11.2 - 17.1岁）时接受了PVR。PVR组患者在总体生存率（PVR组为100%，非PVR组为88.7%，p = 0.007）以及20年时的所有不良事件（心律失常、神经系统并发症，PVR组为95.5%，非PVR组为74.6%，p = 0.024）方面均显示出比非PVR组更好的预后。TOF修复时年龄小于1岁（风险比[HR]，2.265；p = 0.01）和既往分流史（HR，2.195；p = 0.008）是需要进行PVR的预测因素。在随访期间，非PVR组发生了10例晚期死亡（5例猝死），主要原因是室性心律失常和右心室衰竭；PVR组有1例晚期死亡（非猝死）。
采用跨环切口修复TOF后的长期生存率是可以接受的。然而，在20年的随访期间经常观察到心律失常。TOF修复时年龄<1岁以及TOF修复前进行分流植入是需要进行PVR的预测因素。
