Department of Cardiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India.
Department of Cardiology, Sree Chitra Tirunal Institute of Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, India.
Ann Thorac Surg. 2022 Sep;114(3):873-880. doi: 10.1016/j.athoracsur.2021.05.080. Epub 2021 Jun 27.
Ideal time of surgery still remains controversial in outflow ventricular septal defect (VSD) with aortic regurgitation (AR). We aimed to identify the prevalence and predictors of postoperative AR progression.
A total of 154 patients with outflow VSD and AR who underwent VSD surgery between 2006 and 2012 were studied retrospectively.
Eighty patients with subpulmonic VSD and 74 with subaortic VSD were followed up for mean 6.32 ± 2.27 years (range, 3-12 years). Of these, 100 had trivial to mild (group A) and 54 had moderate to severe preoperative AR (group B). At follow-up, there was no significant worsening of mean residual AR grade in group A (P = .16) and subpulmonic VSD of group B (P = .083). However, AR grade worsened significantly in subaortic VSD (1.85 ± 0.87 vs 2.21 ± 1.08, P = .005) of group B. Only 2 (both had subaortic VSD) patients of group A developed moderate AR and none required aortic valve replacement (AVR), while 23 (42.60%) of group B patients developed moderate or severe AR and 7 (30.4%) of them required AVR. Moreover, all who needed AVR had subaortic VSD and had undergone valvuloplasty during VSD closure. The 10 years freedom from moderate or severe AR was significantly lower in group B than group A in both VSDs (subaortic VSD 42.5% ± 10.7% vs 89.3% ± 8.1%, P < .01; subpulmonic VSD 66.7% ± 10.3% vs 100%, P< .01). On multiple regression analysis, postoperative residual AR was the only predictor of AR progression (standardized coefficient, 0.48; P < .001) at follow-up.
Mild preoperative AR rarely progressed after VSD repair. However, worsening of AR could not be prevented effectively, even with valvuloplasty, after the development of moderate or severe AR. Mild or more postoperative residual AR requires close follow-up, especially in subaortic VSD.
在伴有主动脉瓣反流（AR）的流出道室间隔缺损（VSD）中，手术的理想时机仍存在争议。我们旨在确定术后 AR 进展的发生率和预测因素。
回顾性分析 2006 年至 2012 年间接受 VSD 手术的 154 例伴有流出道 VSD 和 AR 的患者。
80 例患者为膜周部 VSD，74 例为主动脉瓣下 VSD，平均随访 6.32±2.27 年（范围，3-12 年）。其中，100 例为轻度至中度（A 组），54 例为中度至重度（B 组）。在随访期间，A 组患者的残余 AR 分级无明显加重（P=0.16），B 组患者的膜周部 VSD 无明显加重（P=0.083）。然而，B 组患者的主动脉瓣下 VSD 明显加重（1.85±0.87 与 2.21±1.08，P=0.005）。A 组仅 2 例（均为主动脉瓣下 VSD）患者发展为中度 AR，且均无需主动脉瓣置换术（AVR），而 B 组 23 例（42.60%）患者发展为中度或重度 AR，其中 7 例（30.4%）患者需要 AVR。此外，所有需要 AVR 的患者均有主动脉瓣下 VSD，且在 VSD 关闭时均进行了瓣成形术。在两组患者中，主动脉瓣下 VSD 的 10 年中度或重度 AR 无事件生存率明显低于膜周部 VSD（主动脉瓣下 VSD：42.5%±10.7%与 89.3%±8.1%，P<0.01；膜周部 VSD：66.7%±10.3%与 100%，P<0.01）。多因素回归分析显示，术后残余 AR 是随访时 AR 进展的唯一预测因素（标准化系数，0.48；P<0.001）。
VSD 修复后，轻度术前 AR 很少进展。然而，即使在中度或重度 AR 发生后进行了瓣成形术，AR 的恶化也不能得到有效预防。轻度或更严重的术后残余 AR 需要密切随访，尤其是在主动脉瓣下 VSD 患者中。
