Buratto Edward, Lui Adrienne, Hu Thomas, Naimo Phillip S, Ivanov Yaroslav, d'Udekem Yves, Brizard Christian P, Konstantinov Igor E
Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Heart Research Group, Murdoch Children's Research Institute, Melbourne, Australia.
Department of Paediatrics, University of Melbourne, Melbourne, Australia.
Ann Thorac Surg. 2022 May;113(5):1553-1561. doi: 10.1016/j.athoracsur.2021.07.096. Epub 2021 Sep 4.
Repair of complete atrioventricular septal defect (cAVSD) is achieved with low mortality. However, there is a high rate of reoperation on the left atrioventricular valve (LAVV), which is often attributed to nonclosure of the cleft. Although nonclosure of the cleft has been reported to be a risk factor for reoperation, no randomized controlled or propensity-matched trials have ever been performed. We investigated the effect of cleft closure on outcomes after cAVSD repair.
We reviewed 455 patients who underwent cAVSD repair between 1990 and 2019. To determine the effect of cleft closure, propensity score matching was performed on risk factors for reoperation after cAVSD repair.
Median age was 3.6 months (mean, 9.6 ± 20.4 months), median weight was 4.3 kg (mean, 4.7 ± 4.3 kg) and 41.9% (191 of 455) were male. Early mortality was 2.9% (13 of 455), and survival was 89.8% ± 1.9% at 20 years. Early reoperation was a risk factor for mortality (P = .004). Freedom from reoperation was 72.5% ± 4.0% at 20 years. Freedom from LAVV reoperation was 74.1% ± 4.0% at 20 years. Preoperative severe LAVV regurgitation (P < .001) and early postoperative moderate or greater LAVV regurgitation (P = .007) were risk factors for reoperation, while trisomy 21 (P = .03) and recent era of surgery (P = .02) were protective. Propensity score matching yielded 106 pairs. There were no differences in long-term survival (P = .71) or reoperation (P = .26) between the 2 groups.
Repair of cAVSD can be achieved with low mortality and good long-term survival, although the reoperation rate remains high. Similar freedom from reoperation can be achieved with or without closure of the LAVV cleft.
完全性房室间隔缺损（cAVSD）修复术的死亡率较低。然而，左房室瓣（LAVV）再次手术率较高，这通常归因于瓣叶裂未闭合。虽然瓣叶裂未闭合已被报道为再次手术的危险因素，但从未进行过随机对照试验或倾向匹配试验。我们研究了瓣叶裂闭合对cAVSD修复术后结局的影响。
我们回顾了1990年至2019年间接受cAVSD修复术的455例患者。为了确定瓣叶裂闭合的影响，对cAVSD修复术后再次手术的危险因素进行倾向评分匹配。
中位年龄为3.6个月（平均9.6±20.4个月），中位体重为4.3 kg（平均4.7±4.3 kg），41.9%（455例中的191例）为男性。早期死亡率为2.9%（455例中的13例），20年生存率为89.8%±1.9%。早期再次手术是死亡的危险因素（P = 0.004）。20年时无再次手术率为72.5%±4.0%。20年时无LAVV再次手术率为74.1%±4.0%。术前严重LAVV反流（P < 0.001）和术后早期中度或更严重LAVV反流（P = 0.007）是再次手术的危险因素，而21三体综合征（P = 0.03）和近期手术时代（P = 0.02）具有保护作用。倾向评分匹配产生106对。两组之间的长期生存率（P = 0.71）或再次手术率（P = 0.26）无差异。
cAVSD修复术死亡率低，长期生存率良好，尽管再次手术率仍然较高。无论是否闭合LAVV瓣叶裂，均可获得相似的无再次手术率。
