部分性和过渡性房室间隔缺损儿童的手术治疗结果。
Surgical Outcomes in Children With Partial and Transitional Atrioventricular Septal Defect.
机构信息
Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo, Japan.
Department of Public Health, 13131Tokyo Women's Medical University, Tokyo, Japan.
出版信息
World J Pediatr Congenit Heart Surg. 2022 Jul;13(4):451-457. doi: 10.1177/21501351221100140.
BACKGROUND
This study aimed to evaluate the long-term outcomes of partial and transitional atrioventricular septal defect repair, focusing on left atrioventricular valve reoperation.
METHODS
We conducted a retrospective review of 104 children who underwent partial or transitional atrioventricular septal defect repair between August 1983 and January 2021. The major outcomes included patient survival and left atrioventricular valve reoperation.
RESULTS
Median age at repair was 4.0 (0.1-17.0) years, with 17 patients being infants (age ≤ 1 year; 16.3%). All but eight patients (92.3%) underwent left atrioventricular valve cleft closure. After initial repair, there were 18 cases of moderate-to-severe left atrioventricular valve regurgitation (17.3%). Three in-hospital deaths (2.9%) and four late deaths (3.8%) occurred. At follow-up (median 14.3 years), actuarial survival was 95.1% and 93.0% at 1 and 20 years, respectively, and 16 patients (15.4%) had undergone a total of 19 left atrioventricular valve reoperations. Initial repair performed during infancy was associated with significantly higher mortality than a repair performed after infancy (35.3% vs 1.5%, < .01, hazard ratio = 26.4). On multivariable analysis, repair during infancy was associated with mortality ( < .01, hazard ratio = 27.4, 95% confidence interval = 2.7-283). Partial or no cleft closure of left atrioventricular valve ( = .03, hazard ratio = 4.7, 95% confidence interval = 1.2-18.8) and moderate-to-severe left atrioventricular valve regurgitation after repair ( < .01, hazard ratio = 9.9, 95% confidence interval = 3.0-32.2) were associated with left atrioventricular valve reoperation.
CONCLUSIONS
Partial and transitional atrioventricular septal defect repair outcomes were generally satisfactory. However, repair during infancy had worse survival outcomes, and moderate-to-severe left atrioventricular valve regurgitation after a repair was associated with future left atrioventricular valve reoperation.
背景
本研究旨在评估部分和过渡性房室间隔缺损修复的长期结果，重点关注左房室瓣再次手术。
方法
我们回顾性分析了 1983 年 8 月至 2021 年 1 月期间接受部分或过渡性房室间隔缺损修复的 104 名儿童患者的资料。主要结局包括患者生存率和左房室瓣再次手术。
结果
修复时的中位年龄为 4.0（0.1-17.0）岁，其中 17 名患者为婴儿（年龄≤1 岁；16.3%）。除 8 名患者外（92.3%）均进行了左房室瓣裂缺闭合术。初次修复后，有 18 例出现中重度左房室瓣反流（17.3%）。3 例院内死亡（2.9%）和 4 例晚期死亡（3.8%）。随访（中位时间 14.3 年）时， actuarial 生存率分别为 95.1%和 93.0%，1 年和 20 年时分别为 16 例（15.4%）进行了总共 19 次左房室瓣再次手术。婴儿期初次修复与婴儿期后修复相比，死亡率显著升高（35.3%比 1.5%， < .01，风险比=26.4）。多变量分析显示，婴儿期修复与死亡率相关（ < .01，风险比=27.4，95%置信区间=2.7-283）。左房室瓣部分或未闭合（ = .03，风险比=4.7，95%置信区间=1.2-18.8）和修复后出现中重度左房室瓣反流（ < .01，风险比=9.9，95%置信区间=3.0-32.2）与左房室瓣再次手术相关。
结论
部分和过渡性房室间隔缺损修复的结果总体上是令人满意的。然而，婴儿期修复的生存率较差，修复后出现中重度左房室瓣反流与未来左房室瓣再次手术相关。
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