Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Shanghai, China.
Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Shanghai, China.
Semin Thorac Cardiovasc Surg. 2021 Winter;33(4):1069-1079. doi: 10.1053/j.semtcvs.2021.07.012. Epub 2021 Jul 18.
This study reviewed the midterm outcomes of supravalvular aortic stenosis (SVAS) repair and determined the risk factors associated with postoperative aortic or pulmonary stenosis. We retrospectively reviewed 225 patients who underwent surgical correction of SVAS from 2010 to 2019. A total of 178 (79.1%), 44 (19.6%) and 3 (1.3%) patients underwent McGoon, Doty, and Brom repair, respectively. The median age at surgery was 2.2 years (interquartile range, 1.2-4.4). The median follow-up time was 3.7 years (interquartile range, 1.9-5.7). Early and late mortality rates were 3.1% and 1.4%, respectively. The overall 5-year survival rate was 97.9%. Eleven patients received reintervention, including 6 (2.8%) reoperations and 5 (2.3%) balloon dilatations. Higher preoperative pressure gradient at the distal ascending aorta or aortic arch was a risk factor for reintervention (P = 0.04). Rates of mortality and complications were not related to the surgical technique. Eleven patients (5.2%) developed sinotubular junction (STJ) stenosis. Freedom from postoperative distal artery stenosis (DAS) of type II SVAS was significantly lower than that of type I (P < 0.01). Higher preoperative pressure gradient at the STJ (P < 0.01) and concomitant bilateral or peripheral pulmonary artery (PA) stenosis (P < 0.01) were risk factors for postoperative DAS. Postoperative PA stenosis occurred more frequently in patients who received bilateral pulmonary arterioplasty (P < 0.01). Postoperative prognosis of the aortic root after SVAS repair was satisfactory. DAS and PA stenosis were common. The results of bilateral pulmonary arterioplasty were unsatisfactory. The surgical timing and technique for PA stenosis should be carefully considered.
这项研究回顾了主动脉瓣上狭窄（SVAS）修复的中期结果，并确定了与术后主动脉或肺动脉狭窄相关的危险因素。我们回顾性分析了 2010 年至 2019 年期间接受 SVAS 手术矫正的 225 例患者。178 例（79.1%）、44 例（19.6%）和 3 例（1.3%）患者分别接受了 McGoon、Doty 和 Brom 修复。手术时的中位年龄为 2.2 岁（四分位距，1.2-4.4）。中位随访时间为 3.7 年（四分位距，1.9-5.7）。早期和晚期死亡率分别为 3.1%和 1.4%。总体 5 年生存率为 97.9%。11 例患者接受了再次介入治疗，包括 6 例（2.8%）再次手术和 5 例（2.3%）球囊扩张。远端升主动脉或主动脉弓的术前压力梯度较高是再次介入的危险因素（P = 0.04）。手术技术与死亡率和并发症无关。11 例（5.2%）患者发生窦管交界（STJ）狭窄。术后 II 型 SVAS 远端动脉狭窄（DAS）的无事件生存率明显低于 I 型（P < 0.01）。STJ 较高的术前压力梯度（P < 0.01）和伴双侧或外周肺动脉（PA）狭窄（P < 0.01）是术后 DAS 的危险因素。双侧肺动脉成形术患者术后 PA 狭窄更为常见（P < 0.01）。SVAS 修复后主动脉根部的术后预后令人满意。DAS 和 PA 狭窄很常见。双侧肺动脉成形术的结果并不理想。PA 狭窄的手术时机和技术应仔细考虑。
